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Liu Z, Liu J, Li J, Li Y, Sun J, Deng Y, Zhou H. Discovery of CTSK+ Periosteal Stem Cells Mediating Bone Repair in Orbital Reconstruction. Invest Ophthalmol Vis Sci 2023; 64:30. [PMID: 37639249 PMCID: PMC10461643 DOI: 10.1167/iovs.64.11.30] [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] [Received: 12/29/2022] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose The purpose of this study was to explore the role of cathepsin K positive (CTSK+) periosteal stem cells (PSCs) in orbital bone repair and to clarify the source of endogenous stem cells for orbital bone self-repair. Methods Periosteum samples obtained by clinical orbital bone repair surgery were analyzed, after which immunofluorescence and immunohistochemical staining were used to detect the content of bone marrow-derived cells and CTSK+ PSCs in periosteum as well as the mobilization of PSCs. CTSK+ PSCs were characterized by flow cytometry. Transcriptome sequencing was used to compare the transcriptomic characteristics of CTSK+ PSCs and bone marrow mesenchymal stem cells (BMSCs). Results The orbital periosteum contained CTSK+CD200+ cell lineage, including CD200+CD105- PSCs and CD200+CD105+ progenitor cells. CTSK and osteocalcin (OCN) colocalized in the inner layer of the orbital periosteum, suggesting the osteogenic differentiation potential of CTSK+ PSCs. CTSK expression was much higher in periosteum after mobilization. Immunofluorescence showed low amounts of scattered CD31+ and CD45+ cells in the orbital periosteum. The stem cell characteristics of CTSK+ PSCs were verified by multidirectional differentiation. Flow cytometry found CD200+CD105- CTSK+ PSCs and CD200variantCD105+ progenitor cells. Transcriptome sequencing of CTSK+ PSCs and BMSCs found 3613 differential genes with significant differences. Gene Ontology (GO) analysis showed the differences between the two types of stem cells, revealing that PSCs were more suitable for intramembranous osteogenesis. Conclusions CTSK+ PSCs may be endogenous stem cells for orbital bone repair. They are mobilized after orbital fracture and have unique features suitable for intramembranous osteogenesis, completely different from BMSCs.
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Affiliation(s)
- Zeyang Liu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jin Liu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jipeng Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuan Deng
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Folkestad L, Jönsson L, Karlsson T. Orbital floor fractures-a comparison between CT images and findings at surgery. Eur Arch Otorhinolaryngol 2023; 280:2795-2803. [PMID: 36625866 PMCID: PMC10175405 DOI: 10.1007/s00405-022-07801-0] [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: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The present study aims to investigate how well CT images correlate to surgical findings in orbital floor fractures and to the presence of diplopia. METHODS In this cross-sectional study, 27 consecutive patients already selected for surgery due to an orbital floor fracture underwent a routine CT scan (axial, coronal, sagittal). An ophthalmologist established any presence of diplopia. Extent of fracture/injury seen on CT was compared to that discovered during surgery. RESULTS In the surgeons´ opinions CT-images were in concordance with surgical findings in 71% of the cases. Agreement for pure blow out fractures was high (92%). Tetrapod fractures as a cause of an orbital floor fracture was only identified as such by surgeons in three of 11 cases, all subjected to orbital exploration, not only a closed reduction. Diplopia showed a significant correlation to rounding of the inferior rectus muscle at coronal CT. "Rounding" significantly correlated with the presence of a floor defect, to herniation of soft tissues and to the volume of displaced tissue. CONCLUSIONS The results imply that the joint professional interaction between neuroradiology and surgery is important and would benefit from the use of an easy and well-defined classification system of orbital floor fractures. In Sweden a national record to collect data on all zygomaticomaxillary complex fractures assessed is to be started aiming at making general statements possible by time.
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Affiliation(s)
- Lena Folkestad
- ENT-Clinic, Södra Älvsborg Hospital, Borås, Sweden.,Department of Otolaryngology, Gothenburg University, 413 45, Gothenburg, Sweden
| | - Lars Jönsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg University, 413 45, Gothenburg, Sweden
| | - Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Maher DI, Hall AJ, Gwini S, Ben Artsi E. Patient-specific Implants for Orbital Fractures: A Systematic Review. Ophthalmic Plast Reconstr Surg 2022; 38:417-424. [PMID: 34750315 DOI: 10.1097/iop.0000000000002089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Orbital fractures are common facial fractures that can be challenging to repair and require careful attention to avoid unacceptable ophthalmic complications. Customized implants that are unique to an individual patient, or patient-specific implants (PSIs), have been increasingly used to repair orbital wall fractures. This systematic review summarizes the current evidence regarding custom-made orbital wall implants. METHODS A keyword search of published literature from January 2010 to September 2021 was performed using Ovid MEDLINE, PubMed, and the Cochrane Library databases. Original articles that included more than 3 human subjects with an orbital fracture repaired with a PSI were included. The search results were reviewed, duplicates were removed and relevant articles were included for analysis. RESULTS Fifteen articles meeting the inclusion criteria. The articles were categorized into 3 separate groups based on the method of PSI fabrication: manual molding of a PSI on a 3D-printed orbital model (53%), directly from a 3D printer (27%), or via a template fabricated from a 3D printer (20%). Three primary postoperative outcomes were assessed: rates of diplopia, enophthalmos, and orbital volume. Postoperative rates of diplopia and enophthalmos improved regardless of the PSI technique, and postoperative orbital volumes were reduced compared with their preoperative state. When PSIs were compared to conventional implants, patient outcomes were comparable. CONCLUSIONS This review of existing PSI orbital implant literature highlights that while PSI can accurately and safely repair orbital fractures, patient outcomes are largely comparable to orbital fractures repaired by conventional methods, and PSI do not offer a definitive benefit over conventional implants.
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Affiliation(s)
- Dominic I Maher
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - StellaMay Gwini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Department of Ophthalmology, Alfred Hospital, Melbourne, Victoria, Australia
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Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2021. [DOI: 10.3390/ohbm2030007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.
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Transoral Endoscopic Plating for Orbital Blowout Fractures. J Craniofac Surg 2021; 32:2835-2839. [PMID: 34183635 DOI: 10.1097/scs.0000000000007726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Orbital fractures account for up to 40% of craniofacial injuries. In this article, the authors present the transoral endoscopy-assisted plating technique for treating orbital blowout fractures (OBF). A retrospective analysis of 56 cases treated with transoral endoscopy-assisted approach was performed. Immediate versus delayed surgery decision-making was performed by using our 2-week algorithm. The surgical technique included only transoral incisions, forced duction and "pulse" tests, osteotomy, endoscopic inspections, the reduction with a curved elevator and an indwelling balloon, the retrieval of prolapsed fatty tissue back into the orbit, removal of sharp bony fragments, adaptation of the titanium mesh to the orbital floor and its fixation with screws to stable bony structures, reattachment of the osteotomized lateral wall, and postoperative computed tomography (CT) scan with 3D CT reconstruction. The overall success rate of surgeries was 96%. The resolution of comorbidities resulted in a normal globe position, normal eye movement, and the resolution of diplopia. Postoperative complications were insignificant with one case of surgical edema and one case of infection and sequestration that appeared six months after surgery. These results remained unchanged after 20 to 24 months of follow-up. The suggested minimally invasive transoral technique can be effectively implemented in cases of OBF as well as in cases when the medial wall of the orbit is involved. Our results presented a high success rate with minimal rate of complications, thus our technique is a safe way with minimal morbidity for treating OBF.
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Yu J, Zhang J, Chen S, Han Q, Yan H. Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:463. [PMID: 33850860 PMCID: PMC8039696 DOI: 10.21037/atm-21-598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Compared to isolated orbital wall fracture, combined orbital floor and medial wall fractures are more likely to be required surgical correction due to a higher possibility of complications. However, it remains a challenge to repair concomitant orbital fracture using a one-piece implant due to the complex anatomic structures of the orbit. Aiming to reduce surgical difficulties and enhance therapeutic effects, we repaired unilateral combined orbital floor and medial wall fractures using two separated modified titanium mesh plates in this study. Methods A retrospective study was conducted on 21 consecutive patients who presented with unilateral combined orbital floor and medial wall fractures in Tianjin Medical University General Hospital between November 2010 and January 2016. The orbital fractures were repaired with two separated titanium mesh plates. The corner at the transition zone area between the orbital floor and the medial wall was reconstructed simultaneously through a combined transcaruncular and inferior subciliary approach with lateral canthotomy. The pre- and post-operative functions and aesthetic results were evaluated. Results Preoperatively, all patients presented with 3.5-6.5 mm enophthalmos, five patients presented with diplopia with ocular motility limitation in injured eyes, and six patients presented with hypoglobus ranging from 1.5 to 3.5 mm. Orbital floor and medial wall fractures of all patients were successfully repaired with two separated titanium mesh plates. Postoperatively, enophthalmos was improved in all patients, which was less than 2 mm on the last follow-up day. Hypoglobus was disappeared in all six patients postoperatively. Diplopia was resolved in five patients within 3 months post operation, and was reduced in one patient. Conclusions In cases of unilateral concomitant orbital floor and medial wall fractures, two titanium mesh plates implantation is a safe and effective procedure. It is worthwhile to take the technique into account when the key points to consider when applying this method include reconstruction of the special orbital shape and the complete return reposition of prolapsed intraorbital soft tissues were intended.
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Affiliation(s)
- Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingkai Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Han
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-repair, and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
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Brasileiro BF, Sickels JEV, Cunningham LL. Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis. J Korean Assoc Oral Maxillofac Surg 2020; 46:428-434. [PMID: 33377469 PMCID: PMC7783186 DOI: 10.5125/jkaoms.2020.46.6.428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/31/2018] [Accepted: 11/17/2018] [Indexed: 11/07/2022] Open
Abstract
Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.
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Affiliation(s)
| | - Joseph E Van Sickels
- Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY, USA
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Barotraumatic Blow-out Fracture of the Medial Orbital Wall by Nose Blowing. J Craniofac Surg 2020; 32:e265-e266. [PMID: 33170822 DOI: 10.1097/scs.0000000000007106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Blow-out fracture is one of the most common facial bone fractures and mainly caused by blunt trauma, whereas barotraumatic causes are relatively rare. In this report, we present the case of a patient with an orbital medial wall blow out fracture caused by nose blowing. This case is unique in that the barotraumatic blow out fracture occurred in a patient without previous known risk factors, except that she had previously been operated on for orbital floor blow-out fracture. It is possible that barotraumatic orbital medial wall fracture occurred due to postoperative changes in the aerodynamics or shock-absorbing capacity of the paranasal sinuses. To prevent barotraumatic trauma in the orbital wall, patients undergoing surgery for orbital fractures should consider avoiding excessive nose blowing not only in the weeks after surgery, but for a sufficient period of time.
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Clinical outcome following intraoperative computed tomography-assisted secondary orbital reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:341-349. [PMID: 32948495 DOI: 10.1016/j.bjps.2020.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Secondary post-traumatic orbital reconstructions are challenging. Portable computed tomography (CT) provides the option to acquire real-time, intraoperative images that help to detect the insufficient reconstruction of the orbit immediately. We retrospectively analyzed patients who received intraoperative CT imaging and analyzed the effect of intraoperative CT scans on revision rates and orbital volume changes before, during, and after surgery. METHODS From August 2014 to September 2016, eleven patients received intraoperative cone-beam CT scans to evaluate the results of secondary orbit reconstruction using Medpor + titanium implants. Patient demographics, surgical details, CT scanning protocol, and follow-up results were analyzed. 3D CT volumetry was used to analyze the orbital volume based on OsiriX MD software. RESULTS Based on intraoperative CT findings, seven cases required intraoperative revision to further augment the orbital cavity or adjust implants. The mean preoperative measured enophthalmos was 3.41±1.4 mm (range: 2-6 mm), which decreased to 0.73±0.4 mm (range: 0-1 mm) at postop assessment (p<0.0001). On the fracture side, there was a significant difference between preoperative vs. intraoperative and preoperative vs. postoperative volume measurements (p<0.01 for both subsets), but no significant difference between intraoperative vs. postoperative measurements. CONCLUSION Intraoperative CT is a valuable tool in secondary orbital reconstruction cases based on clinical enophthalmos evaluation and 3D CT volumetry. For these patients, the avoidance of another revision surgery may outweigh the disadvantage of increased operation time and additional radiation exposure.
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Chai G, Zhang D, Hua W, Yin J, Jin Y, Chen M. Theoretical model of pediatric orbital trapdoor fractures and provisional personalized 3D printing-assisted surgical solution. Bioact Mater 2020; 6:559-567. [PMID: 33005822 PMCID: PMC7501422 DOI: 10.1016/j.bioactmat.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 01/06/2023] Open
Abstract
Pediatric orbital trapdoor fractures are common in children and adolescents and usually require emergency surgical intervention. Herein, a personalized 3D printing-assisted approach to surgical treatment is proposed, serving to accurately and effectively repair pediatric orbital trapdoor fractures. We first investigated stress distribution in external force-induced orbital blowout fractures via numerical simulation, determining that maximum stresses on inferior and medial walls exceed those on superior and lateral walls and thus confer higher probability of fracture. We also examined 36 pediatric patients treated for orbital trapdoor fractures between 2014 and 2019 to verify our theoretical construct. Using 3D printing technique, we then created orbital models based on computed tomography (CT) studies of these patients. Absorbable implants were tailor-made, replicating those of 3D-printed models during surgical repairs of fractured orbital bones. As follow-up, we compared CT images and clinical parameters (extraocular movements, diplopia, enophthalmos) before and 12 months after operative procedures. There were only two patients with diplopia and six with enophthalmos >2 mm at 12 months, attesting to the efficacy of our novel 3D printing-assisted strategy. Numerical simulation is used to theoretically investigate the mechanism of external force-induced orbital blowout fractures. 3D printing--assisted surgical treatment is proposed to effectively repair pediatric orbital trapdoor fractures. Clinical studies are performed by repairing fractured orbital bones via 3D printed customized absorbable implants.
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Affiliation(s)
- Guangrui Chai
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Deming Zhang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611, USA.,The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China
| | - Weijian Hua
- Department of Mechanical Engineering, University of Nevada Reno, Reno, NV, 89557, USA
| | - Jun Yin
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China
| | - Yifei Jin
- Department of Mechanical Engineering, University of Nevada Reno, Reno, NV, 89557, USA
| | - Ming Chen
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
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Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction. J Craniofac Surg 2020; 30:1825-1828. [PMID: 31058723 DOI: 10.1097/scs.0000000000005574] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.
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Abstract
BACKGROUND Significant defects at the fronto-naso-orbital area always present with severe facial disfigurement for the afflicted individuals. It may occur after tumor ablations, compound comminuted fractures, or craniofacial surgeries at this area. PATIENTS AND METHODS Reconstructions of 11 patients with this problem had been performed by the authors, with follow-up for 3 to 25 years. The modes of reconstruction involved carved cartilage block with fascia grafts in 3 patients, split calvarial bone grafting covered with fascia grafts in 2 patients, drilled bone chips harvested from outer table of calvarial bone encased with fascia for smaller defects in 2 patients, 3-dimensional computed tomographic reconstruction and reformation of replica to replace the destroyed framework in 4 patients. RESULTS Patients in this series all achieved good results, with symmetric face, acceptable facial contour, and being willing to attend social activities with deliberate evaluation and planning, selection of proper method, with proficient skills in reconstruction. One patient who received cartilage block grafting came back for refining facial contour 18 years later. CONCLUSIONS Midline fronto-naso-orbital defects could be reconstructed with carved cartilage graft or bone graft, overlaid with fascia graft, intricate asymmetric defects can be reconstructed with the aid of 3-dimensional computed tomographic image reconstruction and reformation of the defect replica to achieve symmetric esthetic result with individualized approaches.
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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Kim H, Son TG, Lee J, Kim HA, Cho H, Jeong WS, Choi JW, Kim Y. Three-dimensional orbital wall modeling using paranasal sinus segmentation. J Craniomaxillofac Surg 2019; 47:959-967. [PMID: 31027858 DOI: 10.1016/j.jcms.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Three-dimensional orbital wall modeling is a time-consuming process because of the presence of pseudoforamina. We developed an automated three-dimensional modeling software to characterize the orbital wall, and evaluated it using data from fracture patients. METHODS We first characterized the air and face regions using multiphase segmentation; the sinuses were segmented by applying morphological operations to air regions. Pseudoforamina of the orbital wall were offset with the segmented sinuses. Finally, the three-dimensional facial bone model, with orbital wall, was reconstructed from the segmented images. RESULTS Ten computed tomography data sets were used to evaluate the proposed method. Results were compared with those obtained using the active contour model and manual segmentation. The process took 31.7 ± 8.0 s, which was 30-60 times faster than other methods. The average distances between surfaces obtained with the proposed method and those obtained with manual segmentation (normal side: 0.20 ± 0.06 mm; fractured side: 0.28 ± 0.10 mm) were approximately half those obtained using the active contour model. CONCLUSIONS Three-dimensional orbital wall models, which were very similar to the manually segmented models, were archived within 1 min using the developed software, regardless of fracture presence. The proposed method might improve the safety and accuracy of surgical procedures.
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Affiliation(s)
- Hannah Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea.
| | - Tae-Geun Son
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Jeonghwan Lee
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Hyeun A Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Hyunchul Cho
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea.
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Biomedical Engineering Research Center, Asan Medical Center, Seoul, Republic of Korea.
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Division of Bio-Medical Science & Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea.
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15
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Shim WS, Jung HJ. Management of Orbital Blowout Fractures: ENT Surgeon's Perspective. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.2.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Woo Sub Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, 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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Doll C, Thieme N, Schönmuth S, Voss JO, Nahles S, Beck-Broichsitter B, Heiland M, Raguse JD. Enhanced radiographic visualization of resorbable foils for orbital floor reconstruction: A proof of principle. J Craniomaxillofac Surg 2018; 46:1533-1538. [PMID: 29983307 DOI: 10.1016/j.jcms.2018.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Despite the advantages and broad applications of alloplastic resorbable implants, postoperative radiological control is challenging due to its radiolucency. The aim of the present study was to evaluate the radiographic visibility of newly developed materials for orbital floor reconstruction. MATERIALS AND METHODS The radiographic visibility of four different material combinations consisting of poly-(L-lactic acid)/poly-glycolic acid (PLLA/PGA) or poly(D,L-lactic acid) (PDLLA) enriched with magnesium (Mg), hydroxyapatite (HA) or β-tricalcium phosphate (β-TCP) with various layers of thicknesses (0.3, 0.6, and 1 mm), surgically placed above the orbital floor of a human head specimen, was evaluated using computed tomography (CT) and cone beam computed tomography (CBCT). The visibility was rated on a scale of 0-10 in CT/CBCT and by Hounsfield Units in CT for each subject. RESULTS All of the materials were clearly detectable in CT scans. Visibility was significantly higher (p < 0.001) in the standard soft tissue window (mean score: 7.3, ranging from 2 to 10) in comparison to the standard bone window (mean score: 5.2, ranging from 1 to 10). In CBCT (mean score: 3.3, ranging from 0 to 7), there was significantly lower but still sufficient visibility of the materials compared to the CT soft tissue window (p < 0.001) and CT bone window (p < 0.001). Comparing the different materials' visibility among the group of same layer thicknesses with each other, in the majority of cases, PDLLA enriched with β-TCP appeared to be most visible in both CT and CBCT. CONCLUSION The incorporation of radiopaque elements to PLLA/PGA and PDLLA polymers is a promising strategy to improve their visibility in CT and CBCT. Our data suggest that the reconstruction of the orbital floor with these new materials could provide an advantageous postoperative radiographic control.
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Affiliation(s)
- Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany.
| | - Nadine Thieme
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Germany
| | - Stefanie Schönmuth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Susanne Nahles
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Benedicta Beck-Broichsitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
| | - Jan-Dirk Raguse
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany
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Arianti A, Irawati Y. Management of old naso-orbital fractures with ocular involvement and associated complications caused by facial trauma. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v27i1.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
A 14-years-old boy came with chief complaint of epiphora and history of globe rupture repair surgery due to facial trauma one year ago. Patient got complications from the trauma, including nasolacrimal duct obstruction, phthisis bulbi, enophthalmos, facial deformities, and ptosis. Multidisciplinary approach was performed simultaneously in one session surgery which included oral mucosal graft for non-irritative phthisis bulbi, silicone block implant for blowout fracture, external dacrycystorhinostomy for obstructed nasolacrimal duct, fascia lata brow suspension/frontalis sling for ptosis, and septorhinoplasty for nasal augmentation. After the surgery, symptoms of epiphora had resolved and aesthetical improvement of facial deformities was also prominent. Management of old orbital fracture poses additional challenges due to the complications that have occurred over time. Loss of functionality may seem impractical to manage because no function can be pertained. Nevertheless, it is important to still perform surgical repair for aesthetic purposes due to the psychological effect on their daily lives.
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Chen CT, Pan CH, Chen CH, Shyu VBH, Wu JCH, Kang GCW. Clinical outcomes for minimally invasive primary and secondary orbital reconstruction using an advanced synergistic combination of navigation and endoscopy. J Plast Reconstr Aesthet Surg 2017; 71:90-100. [PMID: 28958566 DOI: 10.1016/j.bjps.2017.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sequelae of inadequate orbital reconstruction include enophthalmos, hypoglobus, and diplopia. Accuracy of orbital reconstruction is largely subjective and especially difficult to achieve because of anatomic distortion in secondary or late reconstruction and in extensive injury. We combined computer navigation and endoscopy to perform accurate, aesthetic, and safe minimal-access primary and secondary orbital reconstruction. METHODS From 2013 to 2014, 24 patients underwent unilateral primary and secondary or late minimally invasive orbital reconstruction with mainly Medpor and/or titanium mesh by navigation and endoscopic assistance through transantral, transconjunctival, or upper blepharoplasty approaches. Mean follow-up was 13.8 months (range, 6.2 months to 2.8 years). RESULTS All orbital fractures were successfully reduced. Average enophthalmos among patients who underwent early reconstruction, late reconstruction, and multiorbital wall repair improved (p < .001) to 0.2 mm from 1.6, 2.6, and 2.6 mm, respectively. Hypoglobus and diplopia resolved in all. In early reconstruction patients, mean interorbital volume difference improved from 1.72 ± 0.87 to 0.53 ± 0.83 ml (P = .03). For late reconstruction patients, this difference improved from 3.41 ± 1.23 to 0.56 ± 0.96 ml (p < .001). There were no major complications during follow-up, and all were satisfied with their final appearance and function. CONCLUSION Navigation sharpens reconstructive accuracy and avoids injury to vital structures. Combined with endoscopic assistance for minimal-access reconstruction of wide-ranging orbital defects from primary to secondary or late cases and to extensive multiwall fractures, navigation facilitates minimal cosmetic incision and synergistic endoscope use and clearly optimizes aesthetic and functional outcomes, all with enhanced safety and unparalleled intraoperative visualization.
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Affiliation(s)
- Chien-Tzung Chen
- Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Chun-Hao Pan
- Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chih-Hao Chen
- Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Victor Bong-Han Shyu
- Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - John Chung-Han Wu
- Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Gavin Chun-Wui Kang
- Department of Plastic, Reconstructive, and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
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Evaluation of a Radiological Score in the Management of Pure Fractures of the Orbital Floor. J Craniofac Surg 2017; 28:e344-e349. [DOI: 10.1097/scs.0000000000003583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Evolving concepts in the management of orbital fractures with enophthalmos: A retrospective comparative analysis. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2015.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dubois L, Steenen S, Gooris P, Bos R, Becking A. Controversies in orbital reconstruction—III. Biomaterials for orbital reconstruction: a review with clinical recommendations. Int J Oral Maxillofac Surg 2016; 45:41-50. [DOI: 10.1016/j.ijom.2015.06.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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Suomalainen A, Stoor P, Mesimäki K, Kontio RK. Rapid prototyping modelling in oral and maxillofacial surgery: A two year retrospective study. J Clin Exp Dent 2015; 7:e605-12. [PMID: 26644837 PMCID: PMC4663063 DOI: 10.4317/jced.52556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/05/2015] [Indexed: 11/09/2022] Open
Abstract
Background The use of rapid prototyping (RP) models in medicine to construct bony models is increasing. Material and Methods The aim of the study was to evaluate retrospectively the indication for the use of RP models in oral and maxillofacial surgery at Helsinki University Central Hospital during 2009-2010. Also, the used computed tomography (CT) examination – multislice CT (MSCT) or cone beam CT (CBCT) - method was evaluated. Results In total 114 RP models were fabricated for 102 patients. The mean age of the patients at the time of the production of the model was 50.4 years. The indications for the modelling included malignant lesions (29%), secondary reconstruction (25%), prosthodontic treatment (22%), orthognathic surgery or asymmetry (13%), benign lesions (8%), and TMJ disorders (4%). MSCT examination was used in 92 and CBCT examination in 22 cases. Most of the models (75%) were conventional hard tissue models. Models with colored tumour or other structure(s) of interest were ordered in 24%. Two out of the 114 models were soft tissue models. Conclusions The main benefit of the models was in treatment planning and in connection with the production of pre-bent plates or custom made implants. The RP models both facilitate and improve treatment planning and intraoperative efficiency. Key words:Rapid prototyping, radiology, computed tomography, cone beam computed tomography.
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Affiliation(s)
- Anni Suomalainen
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center)
| | - Patricia Stoor
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Risto K Kontio
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
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A Case of Aggravated Medial Orbital Wall Fracture After Reduction of Orbital Floor Fracture. J Craniofac Surg 2015; 26:e691-3. [PMID: 26594974 DOI: 10.1097/scs.0000000000002118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Concomitant fractures of the inferior and medial orbital wall can cause more severe orbital symptoms and lead to incomplete reduction postoperatively. This report presents the case of a 17-year-old boy, presenting with persistent diplopia and enophthalmos after floor reduction for concomitant fractures. At the time of the fracture, surgery was performed for only the orbital floor by a plastic surgeon, because the medial wall fracture was minimal. However, he presented with persistent orbital symptoms after surgery. An aggravated medial wall fracture was discovered via computed tomography (CT) examination. It was treated with a minimal-invasive method using an endoscopic approach.
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Correction of orbital wall fracture close to the optic canal using computer-assisted navigation surgery. J Craniofac Surg 2015; 24:1118-22. [PMID: 23851752 DOI: 10.1097/scs.0b013e318290266a] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Repairing orbital wall fractures can result in serious complications, including enophthalmos, diplopia, or even blindness. Especially, surgeons worry about damaging the optic nerve while dissecting the optic canal area. We avoid these complications by using a navigation system that was adapted to stereotactic concept based on three-dimensional imaging of the patient's anatomy. Here, we report 5 cases of orbital wall fracture that were repaired using a navigation system. METHODS The Navigation System II (Stryker, Freiburg, Germany) and the iNtellect Cranial Navigation (version 1.1) platform were used for each operation. A computer-assisted navigation surgery was performed according to the following procedures: (1) image set, (2) planning, (3) apparatus setup, (4) registration, and (5) intraoperative navigation. Operations were performed under general anesthesia. Dissection was performed up to the periosteum immediately anterior to the optic canal, near the fracture. Vulnerable surrounding structures were identified with the intraoperative pointer. After navigation, we inserted an implant into the defect, successfully, avoiding damage to the optic canal and optic nerve. RESULTS None of the patients had any surgical complications. Postoperative computed tomography scans demonstrated that the fractures were corrected, and continuity was maintained without displacement. The three-dimensional image allowed us to easily visualize intraoperative anatomical structure, allowing us to avoid unnecessary procedures and to correct the orbital wall. The mean volume of fractured orbital cavity was 29.2 cm(3) (range, 28.3-30.4 cm(3)) preoperatively and 27.0 cm(3) (range, 25.9-28.5 cm(3)) postoperatively; thus, the defects were corrected by 2.2 cm(3) (range, 1.3-2.8 cm(3)) on average. CONCLUSIONS We used a navigation system to perform accurate and safe surgery in patients with extensive orbital wall fracture, including around the optic canal. By using the functions to visualize the locations indicated by the pointer, we were able to perform successful dissections and implantations in areas adjacent to the optic canal. The good outcomes obtained here provide evidence that surgical correction of the orbital wall using a navigation system is useful in cases of deep, extensive orbital wall fracture.
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Modified Transconjunctival Lower Lid Approach for Orbital Fractures in East Asian Patients. Plast Reconstr Surg 2014; 134:1023-1030. [DOI: 10.1097/prs.0000000000000639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Three-dimensional pre-bent titanium implant for concomitant orbital floor and medial wall fractures in an East asian population. Arch Plast Surg 2014; 41:480-5. [PMID: 25276638 PMCID: PMC4179350 DOI: 10.5999/aps.2014.41.5.480] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 12/18/2013] [Indexed: 11/25/2022] Open
Abstract
Background The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. Methods Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. Results Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. Conclusions Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.
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The temporoparietal adipofascial flap for the correction of recurrent idiopathic enophthalmos. J Craniofac Surg 2014; 25:676-8. [PMID: 24621720 DOI: 10.1097/scs.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enophthalmos, the posterior displacement of a normal-size ocular globe relative to the orbital cavity, is usually repaired using autogenous grafts or alloplastic materials. We present the case of a 40-year-old man with bilateral idiopathic enophthalmos whose symptoms recurred 8 years after initial successful surgical repair. We describe the successful and safe use of a bilateral temporoparietal adipofascial flap in the treatment of recurrent idiopathic enophthalmos.
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Orbital fractures in children: A review of outcomes. Br J Oral Maxillofac Surg 2013; 51:789-93. [DOI: 10.1016/j.bjoms.2013.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 05/12/2013] [Indexed: 11/21/2022]
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Abstract
PURPOSE To evaluate the experience with sterilized x-ray film in the repair of orbital blow-out fractures (BOFs). METHODS A retrospective review of case notes from 56 patients with orbital BOF repaired using sterilized x-ray film onlay implants at 2 institutions between November 2004 and December 2010. Patient demographics, timing of surgery, surgical approach, postoperative complications, and length of follow up were recorded. RESULTS Fifty-six patients (44 men, 12 women) received sterilized x-ray film implants during the 6-year study period. Mean age at the time of repair was 29 years (range 4-85 years). For 68% of patients, surgical repair was performed within 2 weeks of injury. Average length of postoperative follow up was 5.5 months (range 1-36 months), 48% had follow up >3 months. Following surgical repair, diplopia in primary or down gaze reduced from 98% to 4% and enophthalmos ≥2 mm reduced from 21% to 5% cases. One patient required a second operation for repositioning of an incompletely reduced fracture. A second patient presented 9 months postoperatively with recurrent episodes of proptosis, and the implant and its surrounding pseudocapsule were subsequently removed. There were no cases of visual loss, implant infection, or migration. CONCLUSIONS This series has demonstrated that in selected orbital fractures sterilized x-ray film can provide a safe, effective, and low-cost onlay implant.
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Zhou H, Deng Y, Bi X, Xiao C, Wang Y, Sun J, Gu P, Fan X. Orbital wall repair in canines with beta-tricalcium phosphate and induced bone marrow stromal cells. J Biomed Mater Res B Appl Biomater 2013; 101:1340-9. [PMID: 23687075 DOI: 10.1002/jbm.b.32951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/05/2013] [Accepted: 03/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Huifang Zhou
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Yuan Deng
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Xiaoping Bi
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Caiwen Xiao
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Yefei Wang
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Jing Sun
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Ping Gu
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
| | - Xianqun Fan
- Department of Ophthalmology; Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
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Andrews BT, Surek CC, Tanna N, Bradley JP. Utilization of computed tomography image-guided navigation in orbit fracture repair. Laryngoscope 2013; 123:1389-93. [PMID: 23649722 DOI: 10.1002/lary.23729] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 07/29/2012] [Accepted: 08/17/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Brian T Andrews
- Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Infected Medpor implant in the trauma setting. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Retrospective analysis of 314 orbital fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:168-71. [DOI: 10.1016/j.tripleo.2011.01.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 11/21/2022]
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