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Thomas AB, Pawar SS. Approaches to the Maxillofacial Skeleton: Application of Standard and Minimally Invasive Techniques. Otolaryngol Clin North Am 2023; 56:1079-1088. [PMID: 37353367 DOI: 10.1016/j.otc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Management of maxillofacial trauma is complex and challenging and requires a clear understanding of facial anatomy and function. There are multiple approaches that can be used to access each anatomical region, each with specific indications and complication profiles. Open, "invasive" approaches are being replaced or augmented with minimally invasive and endoscopic approaches when possible. Thorough knowledge of indications, surgical techniques, and potential complications allows surgeons to make appropriate decisions for access and repair of fractures. This article is a comprehensive review of standard and minimally invasive approaches, with description of techniques and pros and cons for their use.
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Affiliation(s)
- Abigail B Thomas
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Pitak-Arnnop P, Witohendro LK, Tangmanee C, Subbalekha K, Sirintawat N, Neff A, Meningaud JP. Assessing effectiveness of endoscope-assisted medial orbital wall fracture repair vs. no surgery using benefit-risk metrics and literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101267. [PMID: 35988910 DOI: 10.1016/j.jormas.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSES To evaluate clinical usefulness of endoscope-assisted medial orbital wall fracture repair via the retrocaruncular approach (rc-EAMOWFR) vs. no surgery (NS), and to perform a narrative review of relevant literature. METHODS This was a retrospective cohort study enrolling isolated medial orbital wall fracture (IMOWF) eyes presented to two German level 1 trauma centers during a 7-year interval. The predictor variable was treatment type (rc-EAMOWFR vs. NS), and the main outcomes were late enophthalmos (LE) and retrobulbar hemorrhage (RH) assessed at 9-15 posttraumatic months. Descriptive and bivariate statistics were computed at α = 95%. Binary adjustments enabled calculation of number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LHH) for demonstrating benefit-risk tradeoffs. Moreover, a narrative review was also performed. RESULTS The sample comprised 502 patients (28.3% females; mean age, 46.5±19.2 years) with 541 IMOWF eyes (5.9% NS; 7.2% LE; 1.3% RH). Operated eyes had significantly lower LE events than NS eyes (symptomatic IMOWF: P < .0001; 95% confidence interval [CI], .03 to .16; NNT = 2 [95% CI, 1.1 to 6.1]; asymptomatic IMOWF: P < .0001; 95% CI, .01 to .07; NNT = 2 [95% CI, 1.1 to 1.8]). There were 7 (1.5%) RH events following rc-EAMOWFR (P = .99; 95% CI, .06 to 17.4; NNH = 68 [95% CI, 38.3 to 254.2]). LHH calculations posited that rc-EAMOWFR was 34 times more likely to prevent LE than to cause RH, regardless of fracture symptoms. Our results conformed to those of other 15 studies. CONCLUSIONS The results of this study suggest that all IMOWFs be treated. rc-EAMOWFR performed in every 68 IMOWFs would be at risk of one RH event, but prevent 34 eyes from LE due to untreated fractures. Nearly 72% of untreated IMOWFs develop LE after 9 months.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg 35043, Germany.
| | | | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg 35043, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, AP-HP, Faculty of Medicine, Henri Mondor University Hospital, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
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Abstract
The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the gold standard for diagnostic testing. Urgent surgical intervention for orbital floor fractures should occur after "white eye" trapdoor fractures or if oculocardiac response occurs. Most orbital fractures do not require urgent intervention and repair can be completed within 2 weeks of injury. There are many approaches to repair orbital fractures, and consideration of techniques depends on the unique fracture pattern. Intraoperative computed tomography has become frequently used and can lead to increased identification of plate malpositioning intraoperatively.
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Affiliation(s)
- John Flynn
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA.
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Kim JH, Lee JY, Lee JY, Shim WS, Wee JH, Jung HJ. Nasal packing with Merocel in a glove finger after endoscopic endonasal reduction of medial blowout fracture. Medicine (Baltimore) 2021; 100:e27277. [PMID: 34559132 PMCID: PMC8462625 DOI: 10.1097/md.0000000000027277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
After endoscopic endonasal reduction (EER) for medial blowout fracture (BOF), nasal packing may be necessary for sustaining the reduced orbital contents. This study aimed to introduce a new packing technique using Merocel in a glove finger.We retrospectively reviewed 131 patients with a mean age of 42.2 years (range, 13-80 years), who underwent EER for medial BOF, followed by a postoperative nasal packing of Merocel in a glove finger, between March 2016 and December 2019. Sex, age, side and cause of trauma, pre-operative diplopia and enophthalmos, duration from the occurrence of trauma to surgery, postoperative diplopia, enophthalmos, complications like sinusitis, and revision surgery were evaluated.The most common cause of injury was physical assault in 47 cases and a fall or slip event in 34. Pre-operatively 22 patients had diplopia and 1 patient had enophthalmos. Mean duration after trauma to the surgery was 13.2 days (range, 1-29 days). The mean operative time was 34.1 minutes (range, 10-70 minutes). Four weeks after operation, the nasal packing was removed at an outpatient clinic, with minimal pain, discomfort, and bleeding and no evidence of infection or inflammation. A computed tomography scan performed at 3 months postoperatively showed no re-bulging. The computed tomography image of 1 patient showed frontal sinus haziness; the patient had a headache and underwent endoscopic sinus surgery for symptomatic relief. Three patients had diplopia and 1 had enophthalmos at final follow-up. No other major postoperative complications were noted.Merocel in a glove finger packing technique proved itself to be safe and effective after EER for medial BOF.
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Affiliation(s)
- Ji Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jun Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | | | - Woo Sub Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
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A novel technique for placing titanium mesh with porous polyethylene via the endoscopic transnasal approach into the orbit for medial orbital wall fractures. Arch Plast Surg 2019; 46:421-425. [PMID: 31550746 PMCID: PMC6759457 DOI: 10.5999/aps.2019.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
Background The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. Methods Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. Results Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. Conclusions We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.
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Endoscopic-Assisted Removal of a Rare Mucocele Complicating From Alloplastic Medial Orbital Fracture Reconstruction. J Craniofac Surg 2017; 28:967-969. [PMID: 28118188 DOI: 10.1097/scs.0000000000003454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Orbital wall fracture reconstruction is usually recommended to prevent subsequent functional and esthetic complications. Mucocele development following such injuries or its management is recognized but rare sequelae. When they occur, they represent a diagnostic and management dilemma. The authors described a patient with orbital and ethmoidal mucocele. A 62-year-old female patient presented with progressive left exophthalmos 1 year following titanium mesh reconstruction of a medial orbital wall fracture. Computed tomography and magnetic resonance imaging demonstrated an encysted lesion encasing the mesh plate in the left orbit and extending into the ethmoidal sinus. The patient is treated surgically through endoscopic-assisted approach with complete removal of the lesion and lacrimal duct stenting. The patient improved immediately after surgery.
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Kim JY, Kang SM. Endoscopic and Transconjunctival versus Transcaruncular and Transconjunctival Reconstruction of Medial and Inferior Orbital Wall Fractures. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.5.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Yong Kim
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Sung Mo Kang
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
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Modified technique for endoscopic endonasal reduction of medial orbital wall fracture using an absorbable packing. Oral Maxillofac Surg 2016; 21:91-98. [PMID: 27942886 DOI: 10.1007/s10006-016-0606-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to describe a modified technique using only biological dura substitute (Lyoplant®) associated or not to a sheet of Medpore® (porous polyethylene plate) avoiding the use of Silastic® or Merocel® packing for endoscopic endonasal reduction of medial orbital wall fracture. METHODS An interventional case report was used involving two patients with medial orbital wall fracture that were treated with the modified technique. Postoperatively, the patients were evaluated for visual acuity, enophthalmos, extraocular motility, and diplopia. RESULT Twelve months after surgery, patients recovered completely without any residual eye symptoms or complications, and postoperative CT showed a completely corrected medial orbital wall fractures. CONCLUSION The reported technique proved itself to be safe and effective, and it may be expected to have advantages over the conventional endoscopic approach using a non-absorbable packing, avoiding the need for long-term nasal packing and a secondary removal procedure.
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Mishra GS, Bhatt SH. Eye Inside Out: Endonasal Endoscopic Reposition of Eye from Nose with Complete Vision Regainment. Craniomaxillofac Trauma Reconstr 2016; 10:84-88. [PMID: 28210414 DOI: 10.1055/s-0036-1584401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 12/27/2015] [Indexed: 10/21/2022] Open
Abstract
Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position. The patient had vision of counting fingers at 1.5 m on the first postoperative day which improved to 6/24 on last follow-up. Such is the rarity that never before has such a case been described in literature where traumatic displacement of eyeball into the nose has been successfully repositioned by an endonasal endoscope with appreciable regaining of vision. It also further promotes endonasal endoscopic approach in the management of orbital blow out injuries.
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Affiliation(s)
- Girish S Mishra
- Department of Otorhinolaryngology, Head and Neck Surgery, Pramukh Swami Medical College and Shri Krishna Hospital, Anand, Gujarat, India
| | - Sushen Harish Bhatt
- Department of Otorhinolaryngology, Head and Neck Surgery, Pramukh Swami Medical College and Shri Krishna Hospital, Anand, Gujarat, India
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10
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Abstract
Determining safe surgical access to the orbit can be difficult given the complex anatomy and delicacy of the orbital structures. When considering biopsy or removal of an orbital tumor or repair of orbital fractures, careful planning is required to determine the ideal approach. Traditionally, this has at times necessitated invasive procedures with large incisions and extensive bone removal. The purpose of this review was to present newly techniques and devices in orbital surgery that have been reported over the past decade, with aims to provide better exposure and/or minimally invasive approaches and to improve morbidity and/or mortality.
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Affiliation(s)
- Ashley A Campbell
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Department of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Seanna R Grob
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Department of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Department of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Fontanella MM, Tschabitscher M, Rodella LF, Nicolai P. The Inferolateral Transorbital Endoscopic Approach: A Preclinical Anatomic Study. World Neurosurg 2016; 90:403-413. [PMID: 26987633 DOI: 10.1016/j.wneu.2016.03.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent years, transorbital endoscopic approaches are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomic landmarks, and target anatomic areas. METHODS Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia. Step-by-step dissection of ILTEA was performed to identify the main anatomic landmarks and corridors. Skin incision, dural incision, and boundaries of craniectomy were measured. Neuronavigation was used to check landmarks, track boundaries of surgical volumes, and measure orbital dislocation. RESULTS The study on the 14 ILTEAs defined 1 anatomic area ("waterline door") that leads to 4 corridors: Meckel's cave corridor, carotid foramen corridor, petrous corridor, and transdural middle fossa corridor. Crucial anatomic landmarks were identified and analyzed. Orbital dislocation was <10 mm. CONCLUSIONS ILTEA provides the surgeon with a direct route to the region of the "waterline door," lateral areas of the ventral skull base, and middle cranial fossa. In addition, it allows an optimal view of the intracranial and extracranial portions of the maxillary and mandibular nerves. Further anatomic and clinical studies are needed to validate ILTEA in surgical practice.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Belotti
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Manfred Tschabitscher
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Copelli C, Manfuso A, d'Ecclesia A, Catanzaro S, Cassano L, Pederneschi N, Tewfik Hanna K, Cocchi R. Endoscopic transnasal approach and intraoperative navigation for the treatment of isolated blowout fractures of the medial orbital wall. J Craniomaxillofac Surg 2015; 43:1974-8. [DOI: 10.1016/j.jcms.2015.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/17/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022] Open
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Ramakrishna R, Kim LJ, Bly RA, Moe K, Ferreira M. Transorbital neuroendoscopic surgery for the treatment of skull base lesions. J Clin Neurosci 2015; 24:99-104. [PMID: 26563603 DOI: 10.1016/j.jocn.2015.07.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 12/30/2022]
Abstract
Transorbital neuroendoscopic surgery (TONES) is a relatively new technique that not only allows access to the contents of the orbit but also the intracranial compartment, including the anterior cranial fossa, middle fossa and lateral cavernous sinus. In this study, we aimed to retrospectively review the largest experience to our knowledge with regards to surgical outcomes of skull base pathologies treated with a TONES procedure. Forty patients (aged 3-89 years) underwent 45 TONES procedures between the years of 2006-2013. Pathologies were cerebrospinal fluid leak repair (n=16), traumatic fracture (n=8), tumor (n=11), meningoencephalocele (n=5), hematoma (n=1), and infection (n=4). Three patients had a persistent complication at 3 months, including a case each of enophthalmos (unnoticed by patient), epiphora (delayed presentation at 2 months requiring dacryocystorhinostomy), and ptosis (improved at 1 year). Surgical success was achieved in all patients. Of special import, there were no cases of visual decline, diplopia, or stroke. There was no mortality. To our knowledge this is the first study and largest experience of TONES (level 4 evidence) to detail outcomes with respect to skull base pathologies. Our results indicate that TONES procedures can be performed with minimal morbidity. Further studies are needed to assess equivalency with craniotomy based approaches though this initial report is encouraging.
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Affiliation(s)
- Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Louis J Kim
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Randall A Bly
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Kris Moe
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA; Department of Otolaryngology, University of Washington School of Medicine, Seattle, WA, USA
| | - Manuel Ferreira
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA.
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Jeong AR, Kang SM. Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.8.1154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ah Reum Jeong
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Sung Mo Kang
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
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Wu W, Jing W, Selva D, Cannon PS, Tu Y, Chen B. Endoscopic Transcaruncular Repair of Large Medial Orbital Wall Fractures Near the Orbital Apex. Ophthalmology 2013; 120:404-9. [DOI: 10.1016/j.ophtha.2012.07.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/26/2012] [Accepted: 07/31/2012] [Indexed: 11/17/2022] Open
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Balakrishnan K, Moe KS. Applications and Outcomes of Orbital and Transorbital Endoscopic Surgery. Otolaryngol Head Neck Surg 2011; 144:815-20. [DOI: 10.1177/0194599810397285] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To prospectively evaluate the safety, effectiveness, and utility of orbital and transorbital endoscopic surgery. Study Design. Case series with planned data collection. Setting. Level 1 trauma center and tertiary academic hospital. Subjects and Methods. Consecutive sample of 107 patients undergoing orbital or transorbital endoscopic operations. Main Outcome Measures. Ability to achieve intraoperative goals using endoscopic approach; occurrence of predetermined intraoperative or postoperative complications. Results. One hundred seven patients (aged 6-83 years) underwent orbital or transorbital endoscopic surgery for 6 different indications. Seven incisions were used. Endoscopic orbitotomies were made through all 4 orbital walls to access surrounding structures. Intraoperative goals were achieved endoscopically in 106 patients. Mean follow-up was 3 months (mean ± SD, 3.0 ± 3.5). No complication was directly related to surgical approach or use of endoscopy. Seventeen complications were detected in 2 categories: persistent diplopia and persistent vision change. No patient had vision loss. No nonfracture patient suffered a complication. Subgroup analysis demonstrated no difference in surgical success rates when compared with transnasal and transantral medial orbital wall and orbital floor repair and cerebrospinal fluid leak repair. Endoscopic visualization was advantageous in several respects: superior visualization and lighting, particularly posterior to the equator of the globe; image magnification; and video monitoring for education and operating room staff involvement. It also facilitated surgical navigation and computer-aided reconstruction. Conclusion. Orbital and transorbital endoscopy are versatile, effective, and safe approaches useful for addressing diverse urgent and elective problems. In appropriate clinical situations, these procedures may offer better access and visualization than open or transnasal approaches.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otolaryngology–Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Kris S. Moe
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, University of Washington, Seattle, Washington, USA
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Abstract
PURPOSE OF REVIEW Orbital trauma is common and frequently complicated by ocular injuries. The recent literature on orbital fracture is analyzed with emphasis on epidemiological data assessment, surgical timing, method of approach and reconstruction materials. RECENT FINDINGS Computed tomographic (CT) scan has become a routine evaluation tool for orbital trauma, and mobile CT can be applied intraoperatively if necessary. Concomitant serious ocular injury should be carefully evaluated preoperatively. Patients presenting with nonresolving oculocardiac reflex, 'white-eyed' blowout fracture, or diplopia with a positive forced duction test and CT evidence of orbital tissue entrapment require early surgical repair. Otherwise, enophthalmos can be corrected by late surgery with a similar outcome to early surgery. The use of an endoscope-assisted approach for orbital reconstruction continues to grow, offering an alternative method. Advances in alloplastic materials have improved surgical outcome and shortened operating time. SUMMARY In this review of modern orbital reconstruction, several controversial issues such as surgical indication, surgical timing, method of approach and choice of reconstruction material are discussed. Preoperative fine-cut CT image and thorough ophthalmologic examination are key elements to determine surgical indications. The choice of surgical approach and reconstruction materials much depends on the surgeon's experience and the reconstruction area. Prefabricated alloplastic implants together with image software and stereolithographic models are significant advances that help to more accurately reconstruct the traumatized orbit. The recent evolution of orbit reconstruction improves functional and aesthetic results and minimizes surgical complications.
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Modified technique for endoscopic endonasal reduction of medial orbital wall fracture using a resorbable panel. Ophthalmic Plast Reconstr Surg 2009; 25:303-5. [PMID: 19617791 DOI: 10.1097/iop.0b013e3181ab64ce] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a modified technique using resorbable panel for endoscopic endonasal reduction of medial orbital wall fracture. METHODS A prospective, small interventional case series involving 2 patients with medial orbital wall fractures that were treated with the modified technique. Postoperatively, patients were evaluated for visual acuity, enophthalmos, extraocular motility, and diplopia. RESULT Both patients recovered completely without any residual eye symptoms or complications, and postoperative CT showed a completely resolved medial orbital wall. CONCLUSION The modified technique for endoscopic endonasal reduction using a resorbable panel was effective for the reconstruction of orbital wall fractures, without complications. The modified technique may be expected to have advantages over the conventional endoscopic approach using a Silastic sheet and Merocel because it does not require long-term nasal packing, and the resorbable panel supports the orbital contents longer.
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Abstract
Endoscopic approaches to maxillofacial trauma have included their use in temporomandibular joint arthroscopy, zygomatic arch repair, repair after orbital trauma, repair of frontal sinus fractures, and finally in the repair of subcondylar mandibular fractures. These techniques provide exciting new options for the management of facial fractures. Many of the techniques provide a steep learning curve and require specialized equipment. The approach to an orbital blowout fracture allows the use of a Caldwell-Luc approach and the use of a naturally occurring body space (the maxillary sinus) for the visualization and maneuvering of the endoscope, tools, and implants. The use of the endoscope in the management of fractures for facial structures such as mandibular subcondylar fractures, which do not have a naturally occurring body cavity, may present greater challenges when trying to obtain visualization, reduction, and fixation. When used for the treatment of subcondylar fractures, wide exposure and the use of right-angled drills and screw drivers may significantly help with this procedure. This may be considered by some surgeons as an endoscopically "assisted" procedure that can possibly be accomplished with direct visualization and the use of dental mirrors. It remains to be seen as to whether some of these diverse endoscopic applications will represent the standard of care in the future or remain a specialized technique practiced by a minority of surgeons in a few specialized centers. This article reviews various endoscopic applications to maxillofacial trauma and discusses some of the controversies of these techniques.
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Abstract
PURPOSE OF REVIEW Many of the successes and controversies in endoscopic management of craniofacial trauma are exemplified in the management of frontal sinus trauma. RECENT FINDINGS The effort to reduce surgical morbidity and to optimize reconstruction of craniomaxillofacial injuries has resulted in the development of less invasive surgical approaches and in the use of computer image guidance in surgical planning and execution. Minimally invasive management of frontal sinus inflammatory disease has gained wide acceptance. The technology and techniques applied to surgery of the floor of the frontal sinus is now being applied to the management of frontal sinus trauma. A paradigm shift in the treatment of frontal sinus trauma may be underway. SUMMARY An increasing scope of less severe injuries is being managed expectantly with endoscopic frontal sinus surgery available for salvage. There may be an overall decrease in the most severe frontal sinus injuries owing to enforcement of seatbelt and airbag usage. And the most severe injuries are often best managed through cranialization with anterior skull base reconstruction. Thus, the role for frontal sinus obliteration purely to obviate fractures of the frontal sinus outflow tract may be vanishing.
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Abstract
PURPOSE OF REVIEW Endoscopic applications in otolaryngology continue to expand, most recently in the area of maxillofacial trauma. Endoscopic management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures has been described. This paper reviews the current literature including new techniques, indications, and outcomes in endoscopic management of facial fractures. RECENT FINDINGS Very few large studies of endoscopic fracture repair exist. The current literature, however, suggests that, when compared with an open approach, smaller endoscopic incisions result in reduced patient morbidity with similar outcomes. Dedicated endoscopic instrumentation and novel surgical approaches continue to be developed. SUMMARY Endoscopic repair of facial fractures is a new and evolving technique that offers the potential for reduced patient morbidity and operating time, as well as quicker patient recovery. Current applications include the management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures. It should be emphasized that endoscopy augments, rather than replaces, the 'time tested' principles of adequate skeletal exposure, accurate fracture reduction, and appropriate internal fixation.
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Affiliation(s)
- Annette M Pham
- Department of Otolaryngology, University of California, Davis School of Medicine, Sacramento, 95817, USA
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Bae YC, Choi SJ, Moon JS, Nam SB. Comparison of the Postoperative Outcome in Pure Medial Orbital Fracture Among Three Groups. Ann Plast Surg 2007; 59:287-90. [PMID: 17721216 DOI: 10.1097/sap.0b013e318031a7ae] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many methods of surgical repair of pure medial orbital fractures have been reported. In this study, we discuss the outcome from the surgical corrections of hydroxyapatite (Biocoral) or porous polyethylene (Medpor) through subciliary approach, and the transnasal endoscopic corrections. Between March 1993 and July 2003, 63 patients were treated with porous polyethylene and 48 patients were treated with hydroxyapatite. Between August 2003 and December 2005, 50 patients were treated with transnasal endoscopic approach. Patients had at least 6 months' follow-up, and the records for diplopia, enophthalmos, and other postoperative complications were reviewed retrospectively. As a result, 1 patient from the group using porous polyethylene, 2 patients from the group using hydroxyapatite, and 1 patient from the endoscopic correction group had enophthalmos. Besides enophthalmos, no other complications were observed. There was no significant statistical correlation among 3 groups. In conclusion, a transnasal endoscopic correction may be considered a useful method for surgical repair of pure medial orbital fractures, with no external facial scar and excellent visualization and accuracy comparable to that of the subciliary approach.
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Affiliation(s)
- Yong-Chan Bae
- Department of Plastic and Reconstructive Surgery, School of Medicine, Pusan National University, Busan, Korea
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14:289-91. [PMID: 16832188 DOI: 10.1097/01.moo.0000233602.37541.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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