안와내벽골절의 진단과 수술에 대한 고찰

오석준,정철훈,이종욱,정찬민 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.6

Medial orbital wall fracture may easily be overlooked because they give clinical symptoms in only a few instances and are located in an area difficult to visualize radiologically. Thus the chance to diagnose this type of fracture depends solely on the thoroughness of the clinical examinations, the skill and persistence to find a medial orbital wall fracture and the type of radiograph taken. We experienced 21 patients with medial orbital wall fractures from 1989 to 1993. The isolated medial orbital wall fractures were 7 cases and combined medial orbital wall fractures were 14 cases and the most common combined fracture was the nasal bone fracture(9 cases). The most common cause of fracture was the traffic accident. The medial orbital wall fracture was confirmed by facial CT scan. In conclusion, the authors state that 1) A medial orbital wall fracture is frequently seen in conjunction with similar type of blow-out fracture of the orbital floor and nasal bone fracture, so careful examination for signs of the medial orbital wall fracture in addition to orbital floor and nasal bone fracture should be carried out. 2) Facial CT scan is superior to conventional radiography in diagnosis of medial orbital wall fractures. 3) In early cases, we used bone graft to correct the medial orbital wall defect, but resorption of the grafted bone was occurred, so recent cases, the alloplastic implants(silastic sheet, titanium mesh) were used.

안와파열골절의 비강내 내시경적 접근을 통한 교정에서 수술 전후 안와 용적 변화

이재우,남수봉,최수종,배용찬,강철욱 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5

Purpose: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. Methods: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change, who took 3 CT scans, pre-, postoperative and 4 months after packing removal. By multiplying cross - section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. Results: The mean orbital volume increment of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrement were 11.0% in group I and 12.46% in group II. Mean volume increment after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). Conclusion: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when there are severe fracture is present.

Reconstruction of Medial Orbital Wall Fractures without Subperiosteal Dissection: The "Push-Out" Technique

Kim, Yong-Ha,Lee, Jin Ho,Park, Youngsoo,Kim, Sung-Eun,Chung, Kyu-Jin,Lee, Jun-Ho,Kim, Tae Gon Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.6

Background Various surgical methods for repairing medial orbital wall fractures have been introduced. The conventional technique requires total separation of the displaced orbital bones from the orbital soft tissues. However, subperiosteal dissection around the fracture can cause additional damage. The aim of the present study is to introduce a method of reconstructing medial orbital wall fractures without subperiosteal dissection named the "push-out" technique. Methods Six patients with post-traumatic enophthalmos resulting from an old medial orbital wall fracture and 10 patients with an acute medial orbital wall fracture were included. All were treated with the push-out technique. Postoperative computed tomography (CT) was performed to assess the correct positioning of the implants. The Hertel scale and a comparison between preoperative and postoperative orbital volume were used to assess the surgical results. Results Restoration of the normal orbital cavity shape was confirmed by examining the postoperative CT scans. In the old fracture group, the median orbital volume of the fractured side was $29.22cm^3$ preoperatively, and significantly improved postoperatively to a value of $25.13cm^3$. In the acute fracture group, the median orbital volume of the fractured side was $28.73cm^3$ preoperatively, and significantly improved postoperatively to a value of $24.90cm^3$. Differences on the Hertel scale also improved, from 2.13 mm preoperatively to 0.25 mm postoperatively in the old fracture group and from 1.67 mm preoperatively to 0.33 mm postoperatively in the acute fracture group. Conclusions The push-out technique can be considered a good alternative choice for old medial orbital wall fractures with posttraumatic enophthalmos, acute medial orbital wall fractures including large fractured bone segments, and single-hinged greenstick fractures.

Reconstruction of Medial Orbital Wall Fractures without Subperiosteal Dissection: The “Push-Out” Technique

김용하,이진호,박영수,김성은,정규진,이준호,김태곤 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.6

Background Various surgical methods for repairing medial orbital wall fractures have been introduced. The conventional technique requires total separation of the displaced orbital bones from the orbital soft tissues. However, subperiosteal dissection around the fracture can cause additional damage. The aim of the present study is to introduce a method of reconstructing medial orbital wall fractures without subperiosteal dissection named the “push-out” technique. Methods Six patients with post-traumatic enophthalmos resulting from an old medial orbital wall fracture and 10 patients with an acute medial orbital wall fracture were included. All were treated with the push-out technique. Postoperative computed tomography (CT) was performed to assess the correct positioning of the implants. The Hertel scale and a comparison between preoperative and postoperative orbital volume were used to assess the surgical results. Results Restoration of the normal orbital cavity shape was confirmed by examining the postoperative CT scans. In the old fracture group, the median orbital volume of the fractured side was 29.22 cm3 preoperatively, and significantly improved postoperatively to a value of 25.13 cm3. In the acute fracture group, the median orbital volume of the fractured side was 28.73 cm3 preoperatively, and significantly improved postoperatively to a value of 24.90 cm3. Differences on the Hertel scale also improved, from 2.13 mm preoperatively to 0.25 mm postoperatively in the old fracture group and from 1.67 mm preoperatively to 0.33 mm postoperatively in the acute fracture group. Conclusions The push-out technique can be considered a good alternative choice for old medial orbital wall fractures with posttraumatic enophthalmos, acute medial orbital wall fractures including large fractured bone segments, and single-hinged greenstick fractures.

Orbital wall restoration with primary bone fragments in complex orbital fractures

박종현,Dong Hee Kang,Hong Bae Jeon,Hyonsurk Kim 대한두개안면성형외과학회 2023 Archives of Craniofacial Surgery Vol.24 No.2

Background: Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration technique in which the primary orbital wall fragments were restored to their prior position in complex orbital fractures in 2020. As a follow-up to a previous preliminary study, this study retrospectively reviewed the surgical results of complex orbital wall fractures over a 4-year period and compared the surgical outcomes by dividing them into groups with and without balloon restoration. Methods: Data of 939 patients with facial bone fractures between August 2018 and August 2022 were reviewed. Of these, 154 had complex orbital fractures. Among them, 44 and 110 underwent reduction with and without the balloon technique respectively. Pre- and postoperative Naugle exophthalmometer (Good-Lite Co.) scales were evaluated. The orbital volume and orbital volume ratio were calculated from preoperative and 6 months postoperative computed tomography images. Results: Among 154 patients with complex orbital fractures, 44 patients underwent restoration with the balloon technique, and 110 patients underwent restoration without it. The Naugle scale did not differ significantly between the two groups, but the orbital volume ratio significantly decreased by 3.32% and 2.39% in groups with and without the balloon technique and the difference in OVR was significantly greater in patients in the balloon restoration group compared with the control group. Postoperative balloon rupture occurred in six out of 44 cases (13.64%). None of the six patients with balloon rupture showed significant enophthalmos at 6 months of follow-up. Conclusion: The balloon rupture rate was 13.64% (6/44 cases) with marginal screw fixation, blunt screws, and extra protection with a resorbable foam dressing. Furthermore, we restored the orbital wall with primary orbital fragments using balloon support in complex orbital wall fractures.

Orbital wall restoration with primary bone fragments in complex orbital fractures: A preliminary study

Jung, Joo Sung,Kang, Dong Hee,Lim, Nam Kyu,Kim, Hyonsurk Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.3

Background: We have reported orbital wall restoration surgery with primary orbital wall fragment in pure blowout fractures using a combination of transorbital and transnasal approach in pure blow out fractures. However, this method was thought to be difficult to use for complex orbital wall fractures, since the sharp screw tip that fixate the maxillary wall increases the risk of balloon ruptures. In this study, we reviewed 23 cases of complex orbital fractures that underwent orbital wall restoration surgery with primary orbital wall fragment and evaluated the result. Methods: A retrospective review was conducted of 23 patients with complex orbital fracture who underwent orbital restoration surgery with primary orbital wall fragments between 2012 and 2019. The patients underwent orbital wall restoration surgery with primary orbital wall fragment with temporary balloon support. The surgical results were evaluated by the Naugle scale and a comparison of preoperative and postoperative orbital volume ratio. Complex fracture type, type of screw used for fixation and complications such as balloon rupture were also investigated. Results: There were 23 patients with complex orbital fracture that used transnasal balloon technique for restoration. 17 cases had a successful outcome with no complications, three patients had postoperative balloon rupture, two patients had soft-tissue infection, and one patient had balloon malposition. Conclusion: The orbital wall restoration technique with temporary balloon support can produce favorable results when done correctly even in complex orbital wall fracture. Seventeen cases had favorable results, six cases had postoperative complications thus additional procedure seems necessary to complement this method.

Lyo-Dura를 이용한 Orbital Floor Fracture의 정복술

이희철,이희원 인제대학교 1982 仁濟醫學 Vol.3 No.4

최근 우리나라는 물론이고 전세계적으로 교통사고등 현대산업사화에서 빈발하는 각종사고로 인하여 악안면 부위의 골절환자가 점증하고 있는 바 이에 대한 적절한 진단과 처치가 구강외과 영역에서 중요한 문제로 대두되고 있다. 이에 본 논제에서는 facial bone fracture가 있을때에 orbital floor를 Lyodura를 이용해서 reconstruction 하는 방법에 대해서 논하고자 한다. Orbital bone trauma, maxillofacial bone fracture, and soft tissue injury are often progressive components of a single or multiple injury pattern. Facial lacerations associated with underlying skeletal damage have been described previously; but its diagnostic significance seldom has been appreciated. Blunt trauma to the region of infraorbit may result in a spectrum of injuries, ranging from minor lacerations or eccymosis to compound fractures. The extent of soft-tissue and skeletal damage is related to the force and direction of impact; a relatively large force seems to be required to produce a infra-orbital-floor fracture, whereas lesser impacts generally result only in soft-tissue injury. When the facial bone is fractured, especially commiunted fracture of the orbital-floor, the bony surface is lost and opened to the maxillary-sinus cavity. Therefore the orbital fascia, the periosteum and the muscle is herniated partially into the cavity. If oral-surgern did not reconstruct the area perfectly, the permanent diplopia is caused by compress the oblique inferior muscle and the rectus inferior muscle. Then we reconstruct the fractured orbital-floor by use of the LYO-DURA effectively. This report describes representative patients with fractures of the infraorbital floor and of the maxillo-facial bone secondary to maxillo-facial-region trauma and suggests a protocol for efficient diagnosis and surgical new technique.

안와벽 골절 면적과 이탈된 안와내 조직의 부피에 따른 안구함몰 정도

장학선(Hak-Sun Jang),임대호(Dae-Ho Leem),백진아(Jin-A Baek),신효근(Hyo-Keun Shin),고승오(Seung-O Ko) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.3

Introduction: The enlargement and deformation of the orbit give rise to a visible enophthalmos. As a consequence, a disturbance of eye motility together with double images is likely to occur. This study examined the degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue in blowout fractures of the medial and inferior orbital wall. Materials and Methods: This study was performed on patients diagnosed with medial and inferior orbital wall fractures at the Department of Oral and maxillofacial surgery, Chonbuk National University Hospital from 2007 to 2009. The patients age, gender, etiology of fracture and degree of enophthalmos were investigated. The changes in the degree of enophthalomos, diplopia and ocular motility restriction after operation were examined. Results: The degree of enophthalomos increased with increasing extent of orbital wall fracture and volume of herniated orbital tissue. Conclusion: Whether to perform the operation is decided after measuring the extent of the orbital wall fracture and volume of herniated orbital tissue using computed tomography (CT), time for the decision of operation can be shortened. This can cause a decrease in the complications of orbital wall fractures.

관골 단독 골절에서 안구 용적 변화의 정량적 분석

정한주,강석주,김진우,김영환,선욱 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.6

Purpose: The zygoma (Zygomaticomaxillary) complexes make up a large portion of the orbital floor and lateral orbital walls. Zygoma fracture frequently causes the posteromedial displacement of bone fragments, and the collapse or overlapping of internal orbital walls. This process consequently can lead to the orbital volume change. The reduction of zygoma in an anterolateral direction may influence on the potential bone defect area of the internal orbital walls. Thus we performed the quantitative analysis of orbital volume change in zygoma fracture before and after operation. Methods: We conducted a retrospective study of preoperative and postoperative three-dimensional computed tomography scans in 39 patients with zygoma fractures who had not carried out orbital wall reconstruction. Orbital volume measurement was obtained through Aquarius Ver. 4.3.6 program and we compared the orbital volume change of injured orbit with that of the normal contralateral orbit. Results: The average orbital volume of normal orbit was 19.68 cm3. Before the operation, the average orbital volume of injured orbit was 18.42 cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.18 cm3 (6.01%) on average. After operation, the average orbital volume of injured orbit was 20.81 cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.17 cm3 (5.92%) on average. Conclusion: There are considerable volume changes in zygoma fracture which did not accompany internal orbital wall fracture before and after operation. Our study reflects the change of bony frame, also that of all parts of the orbital wall, in addition to the bony defect area of orbital floor, in an isolated zygoma fracture so that it evaluates orbital volume change more accurately. Thus, the measurement of orbital volume in isolated zygoma fractures helps predict the degree of enophthalmos and decide a surgical plan.

안면부 둔상 환자에서 유의한 안내 합병증 빈도와 안와골절 및 안면골절 유무와의 연관성

이준식,이화,신형호,이종미,장민욱,백세현 대한안과학회 2012 대한안과학회지 Vol.53 No.5

Purpose: To investigate the frequency of significant intraocular sequelae (SIOS) in orbital blunt trauma and their association with blowout and facial bone fractures. Methods: A retrospective survey consisting of 726 patients with orbital blunt trauma who visited Korea University Medical Center was performed. Patients were divided into three groups: blowout fracture only group (group 1), facial bone fracture group (nasal bone fracture, maxillary fracture, zygoma fracture without blowout fracture, group 2), and non-fracture group (group 3). SIOS (traumatic iridocyclitis, commotio retina, hyphema, retinal hemorrhage, eyeball rupture, vitreous hemorrhage, retinal detachment, lens dislocation, traumatic cataract) were surveyed in each group, and the association between the frequency of SIOS and the presence of blowout fracture or facial bone fracture was analyzed. Results: The frequency of SIOS in the fracture groups was 83.8% in group 1 and 73.3% in group 2, which were both higher than the 67.9% in group 3, the non-fracture group (p = 0.000 by chi-square linear by linear association). Traumatic iridocyclitis and hyphema were also significantly higher in groups 1 and 2 than group 3 (p = 0.003, p = 0.008 by chi-square linear by linear association). Conclusions: SIOS was found significantly more often in the fracture group than the group without fracture, although the frequency of severe SIOS was lower in the fracture group than the non-fracture group. The results from the present study could help in the treatment and management of patients with orbital blunt trauma. J Korean Ophthalmol Soc 2012;53(5):613-617