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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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Zhuang A, Wang S, Yuan Q, Li Y, Bi X, Shi W. Surgical repair of large orbital floor and medial wall fractures with destruction of the inferomedial strut: Initial experience with a combined endoscopy navigation technique. J Plast Reconstr Aesthet Surg 2023; 77:104-110. [PMID: 36563635 DOI: 10.1016/j.bjps.2022.11.005] [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: 12/09/2021] [Revised: 08/24/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
The application of navigation and endoscope is an area of intense interest in the surgical repair of orbital fractures. This study explored the advantages of a combined endoscopy navigation technique (ENT) for repairing large orbital floor and medial wall fractures (OFMWFs) with destruction of the inferomedial strut (IMS). Fifty-two consecutive patients with large OFMWFs with the destruction of the IMS underwent ENT-assisted surgical repair from January 2013 to February 2016. Patient demographics, causes of injury, clinical features, imaging data, and follow-up information (diplopia, ocular dysmotility, enophthalmos, infraorbital hypoesthesia, and other conditions) were collected and analyzed. Orbital volumes and implant positions were also evaluated. The median follow-up duration was 21 (range, 16-29) months. At the end of the follow-up visits, orbital reconstruction was demonstrated by orbital computed tomography. Of the 30 patients with diplopia within the 30-degree visual field of gaze, 27 (90%) reached diplopia remission. Of 40 patients, 34 (85%) achieved complete elimination of ocular dysmotility. Of 47 patients with enophthalmos of >2 mm, 43 (91%) acquired good symmetry with a mean improvement of 3.00 ± 1.00 mm. Of 33 patients, 27 (82%) recovered from infraorbital hypoesthesia. The postoperative orbital volumes of the two sides showed no significant differences (p = 0.087, paired t-test). Early surgical repair showed better outcomes of diplopia, ocular motility, and enophthalmos than late repair (p = 0.001, p = 0.007, and p = 0.000, generalized estimated equations). No patient developed surgery-related complications of visual acuity compromise, strabismus, ectropion, entropion, or lacrimal canaliculus injuries. ENT-assisted surgery appears to be safe, precise, and effective for the repair of large OFMWFs with destruction of the IMS.
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Affiliation(s)
- Ai Zhuang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shaoyun Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qingyue Yuan
- Department of Ophthalmology, Shanghai 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, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Xiaoping Bi
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Wodong Shi
- Department of Ophthalmology, Shanghai 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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Patel S, Shokri T, Ziai K, Lighthall JG. Controversies and Contemporary Management of Orbital Floor Fractures. Craniomaxillofac Trauma Reconstr 2022; 15:237-245. [PMID: 36081678 PMCID: PMC9446276 DOI: 10.1177/19433875211026430] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management modalities. As such, this article aims to review the indications and timing of repair, surgical approaches, materials used for repair, and contemporary adjuncts to repair. Indications for orbital floor fracture repair remain controversial as many of these fractures heal without intervention or adverse sequelae. Intraoperative navigation and imaging, as well as endoscopic guidance, can improve visualization of defects mitigating implant positioning errors, thereby reducing the need for secondary corrective procedures. Patient-specific implants may be constructed to fit the individual patient's anatomy using the preoperative CT dataset and mirroring the contralateral unaffected side and have been shown to improve pre-operative efficiency and minimize postoperative complications. With increased data, we can hope to form evidence-based indications for using particular biomaterials and the criteria for orbital defect characteristics, which may be best addressed by a specific surgical approach.
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Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck
Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck
Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck
Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive Surgery,
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania
State University, Hershey, PA, USA
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Functional and Aesthetic Outcome of Extensive Orbital Floor and Medial Wall Fracture via Navigation and Endoscope-assisted Reconstruction. Ann Plast Surg 2020; 82:S77-S85. [PMID: 30516560 DOI: 10.1097/sap.0000000000001700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Extensive orbital floor and medial wall fractures compared with isolated orbital wall fractures are more likely to require surgical correction because of a higher possibility of complications like diplopia, enophthalmos, or numbness. The unique and complex contours of the orbital anatomy limit the intraoperative view of the intraorbital anatomy, and complex orbital fractures involving the buttress of the transition zone area all make orbital reconstruction surgery more challenging. The aim of this study was to describe our experience with surgical approaches using navigation- and endoscope-assisted guidance for extensive orbital floor and medial wall fracture reconstruction. PATIENTS AND METHODS A retrospective study was conducted on consecutive 17 patients from 2015 to 2017 presenting with unilateral extensive orbital floor and medial wall fractures at the Chang Gung Memorial Hospital, Linkou Branch. The fractures were treated surgically with a preformed mesh plate and layered Medpor (Porex Surgical Inc, Atlanta, Ga) through navigation and endoscopy. The preoperative and postoperative functional and aesthetic outcomes were described. RESULTS All extensive orbital floor and medial wall fractures were successfully reconstructed. Of the 17 patients, 11 experienced diplopia preoperatively, and for 2 of the 11 patients, diplopia improved immediately after surgery. In the remaining 9 patients, diplopia still persisted after surgery; however, diplopia recovered after an average of 3.44 months (range, 1-9 months). Average enophthalmos among the 10 patients, evaluated by postoperative follow-up computed tomography scan, improved from 2.99 to 0.68 mm. There were no major complications during follow-up, and all patients were satisfied with their final appearance and function. CONCLUSIONS On the basis of the results, our surgical approach using preformed titanium mesh plates and Medpor under the assistance of navigation and endoscopy can be a safe, accurate, and effective method for the management of extensive orbital floor and medial wall fractures and clearly optimizes functional and aesthetic outcomes.
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Pankratov AS, Gotsiridze ZP, Kondrat AN, Karalkin AV. Repair of orbital floor fractures via the transantral approach with osteosynthesis plate. Oral Maxillofac Surg 2020; 24:309-316. [PMID: 32415412 DOI: 10.1007/s10006-020-00850-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The most common surgical access techniques employed in patients with orbital floor fractures are associated with a risk of complications, such as implant infection, migration, epiphora, lower eyelid retraction, ectropion, diplopia worsening, retrobulbar hematoma, emphysema, "white-eyed" syndrome, enophthalmia relapse, hypoglobus, and persistent diplopia due to periorbital atrophy. Consequently, alternative access techniques precluding these complications have to be found. STUDY OBJECTIVE To assess the efficacy of transantral approach in the surgical treatment of patients with orbital floor fractures based on results of retrospective analysis of our clinical experience. MATERIALS AND METHODS We performed a retrospective study of medical records and X-ray data of 52 patients with fractures of the floor of the orbit, 18 to 68 years old, treated using transantral approach as described in the article. Titanium plates of special shape were used for orbital floor reconstruction. RESULTS In 94.2% of the cases, adequate restoration of the floor of the orbit was achieved. It led to regression of the ocular signs. In 4 patients, diplopia remained in extreme gaze positions, which did not require surgical correction. The failed cases were related to incorrect positioning of the plate or fixing screws. No inflammatory complications were observed. CONCLUSION Transantral access approach may be a technique of choice in treating patients with orbital floor fractures; it is safe, minimally traumatic, and effective in the early posttraumatic period when the injured area is located in the posterior parts of the floor of the orbit.
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Affiliation(s)
- Alexander S Pankratov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. .,Department of Dentistry, Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
| | - Zauri P Gotsiridze
- Department of Maxillofacial Surgery, First Moscow Municipal Clinical Hospital named N.Y. Pirogov, Moscow, Russia
| | - Artur N Kondrat
- Department of Maxillofacial Surgery, First Moscow Municipal Clinical Hospital named N.Y. Pirogov, Moscow, Russia
| | - Anatolij V Karalkin
- Department of Radiology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Resolution of Diplopia in Late Repair of Enophthalmos Following Facial Trauma. J Craniofac Surg 2018; 29:1006-1011. [PMID: 29561480 DOI: 10.1097/scs.0000000000004430] [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
Posttraumatic enophthalmos due to isolated or complex orbital fractures can contribute to diplopia. Current evidence recommends early repair. However, little is known about the outcome of enophthalmos correction when repair occurs beyond 30 days after trauma. In this systematic review, the authors aim to evaluate the current evidence on functional outcomes after delayed repair of posttraumatic enophthalmos.Two independent assessors undertook a systematic review of the literature using multiple databases. The authors' inclusion criteria identified studies involving patients at least 14 years of age who had surgical correction of persistent enophthalmos 30 days after initial trauma. Each eligible paper was included after critical appraisal using validated guidelines. Data on preoperative and postoperative enophthalmos and diplopia in each study was extracted. The pattern of fracture was also noted.The authors' search for the medical databases yielded 1053 articles, of which 6 eligible papers were included. Meta-analysis was performed. In patients with complex injuries involving orbital and mid-facial fractures, diplopia resolution was calculated to be 53%, and enophthalmos was corrected in 83% of the patients. In patients with isolated orbital fractures, 53% had resolution of their diplopia, and enophthalmos was corrected in 88% of the patients.Enophthalmos can be corrected to within 2 mm of the contralateral eye in both the isolated and complex orbital fractures in patients who present 30 days or greater after injury. Based on the studies reviewed, there is less predictability in diplopia resolution.
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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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Ramphul A, Hoffman G. Does Preoperative Diplopia Determine the Incidence of Postoperative Diplopia After Repair of Orbital Floor Fracture? An Institutional Review. J Oral Maxillofac Surg 2017; 75:565-575. [DOI: 10.1016/j.joms.2016.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/29/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
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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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Endoscopic endonasal versus transfacial approach for blowout fractures of the medial orbital wall. J Craniofac Surg 2016; 26:e247-9. [PMID: 25974823 DOI: 10.1097/scs.0000000000001660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the last decades, the introduction of computed tomography has allowed an increase in the number of diagnosed fractures of the medial orbital wall. To repair medial wall fractures, many surgical techniques have been proposed (1), each one with its advantages and disadvantages. In this study, we compared endoscopic endonasal and transcutaneous reduction approaches in terms of surgery time and clinical outcome. Between 2001 and 2005, 81 patients with orbital wall fractures were treated at our department. Among these 81 patients, 24 (29.63%) were affected by a medial orbital fracture. Patients with fracture to both floor and medial walls underwent floor reduction by a transcutaneous subpalpebral approach (n = 9, 11.1%), whereas patients with isolated medial wall fracture underwent medial wall reduction by a transcutaneous subpalpebral approach using alloplastic implants (n = 8, 9.88%) or were treated by endoscopic approach (n = 5, 6.17%). After surgery, oculomotor function improved in all 22 patients. None of the patients had complications. Computed tomography revealed a well-consolidated site of fracture in both endoscopic endonasal and transcutaneous approaches. The average operating time for endoscopic endonasal and transfacial approach was 50 and 45 minutes, respectively. In this paper, the author proposed a results comparison between the endoscopic approach and the transcutaneous one.
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Endoscopic Management of Orbital Fractures. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dubois L, Jansen J, Schreurs R, Saeed P, Beenen L, Maal TJJ, Gooris PJJ, Becking AG. Predictability in orbital reconstruction: A human cadaver study. Part I: Endoscopic-assisted orbital reconstruction. J Craniomaxillofac Surg 2015; 43:2034-41. [PMID: 26454320 DOI: 10.1016/j.jcms.2015.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 11/17/2022] Open
Abstract
In the treatment of orbital defects, surgeon errors may lead to incorrect positioning of orbital implants and, consequently, poor clinical outcomes. Endoscopy can provide additional visualization of the orbit through the transantral approach. We aimed to evaluate whether endoscopic guidance during orbital reconstruction facilitates optimal implant placement and can serve as a convenient alternative for navigation and intra-operative imaging. Ten human cadaveric heads were subjected to thin-slice computed tomography (CT). Complex orbital fractures (Class III/IV) were created in all eligible orbits (n = 19), which were then reconstructed using the conventional transconjunctival approach with or without endoscopic guidance. The ideal implant location was digitally determined using pre-operative CT images, and the accuracy of implant placement was evaluated by comparing the planned implant location with the postoperative location. There were no statistically significant differences (p > 0.05) in the degree of implant dislocation (translation and rotation) between the transconjunctival orbital reconstruction and the endoscopic-assisted orbital reconstruction groups. Endoscopic-assisted orbital reconstruction may facilitate the visualization of orbital defects and is particularly useful for training purposes; however, it offers no additional benefits in terms of accurate implant positioning during the anatomical reconstruction of complex orbital defects.
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Affiliation(s)
- Leander Dubois
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands.
| | - Jesper Jansen
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Ruud Schreurs
- 3D Laboratory Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Perooz Saeed
- Department of Ophthalmology (Head: Prof. Dr. M.P. Mourits), Orbital Unit, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Ludo Beenen
- Department of Radiology (Head: Prof. Dr. J. Stoker), Academic Medical Centre of Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Thomas J J Maal
- 3D Laboratory Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Peter J J Gooris
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
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Abstract
PURPOSE OF REVIEW A myriad of surgical approaches to the craniomaxillofacial skeleton exist. Depending on the purpose of the procedure and the anatomic area to be addressed, classically used approaches include coronal approach, midfacial degloving, eyelid incisions, and other cutaneous incisions. Over the last decade, endoscopic approaches have become more popular. Whether external, transoral, or endoscopic, a detailed knowledge of the indications, anatomy, limitations, and potential complications is critical to the successful employment of these approaches. This article reviews the recent literature on classic as well as novel advancements to the craniofacial skeleton. RECENT FINDINGS Multiple studies in the last 5 years have investigated the approaches to the craniofacial skeleton. Most of these focus on trauma. Recent advances have concentrated on external versus endoscopic approaches to the mandibular condyle, an endoscopic approach to the midface and orbit, three-dimensional imaging of the facial skeleton, and improving upon the existing classic approaches and techniques. SUMMARY Approaches to the craniomaxillofacial skeleton continue to evolve with the refinement of classic approaches and advent of new technologies and approaches. This study reviews the recent literature and provides a comprehensive review of options for craniofacial exposure and the most up-to-date surgical options.
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Rhee SH, Kim TS, Song JM, Shin SH, Lee JY. Effectiveness of Computed Tomography for Blow-out Fracture. Maxillofac Plast Reconstr Surg 2014; 36:273-9. [PMID: 27489846 PMCID: PMC4283543 DOI: 10.14402/jkamprs.2014.36.6.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis. Methods: Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed. Results: Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was 192.6 mm2 and the mean volume was 673.2 mm3. Group B area was 316.2 mm2 and volume was 1,710.6 mm3. The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume. Conclusion: In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.
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Affiliation(s)
- Seung-Hyun Rhee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Tae-Seup Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Sang-Hoon Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University
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Cheung K, Voineskos SH, Avram R, Sommer DD. A Systematic Review of the Endoscopic Management of Orbital Floor Fractures. JAMA FACIAL PLAST SU 2013; 15:126-30. [DOI: 10.1001/jamafacial.2013.595] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kevin Cheung
- Divisions of Plastic and Reconstructive Surgery (Drs Cheung, Voineskos, and Avram) and Otolaryngology Head and Neck Surgery (Dr Sommer), Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sophocles H. Voineskos
- Divisions of Plastic and Reconstructive Surgery (Drs Cheung, Voineskos, and Avram) and Otolaryngology Head and Neck Surgery (Dr Sommer), Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ronen Avram
- Divisions of Plastic and Reconstructive Surgery (Drs Cheung, Voineskos, and Avram) and Otolaryngology Head and Neck Surgery (Dr Sommer), Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Doron D. Sommer
- Divisions of Plastic and Reconstructive Surgery (Drs Cheung, Voineskos, and Avram) and Otolaryngology Head and Neck Surgery (Dr Sommer), Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Iwai T, Yasumura K, Mikami T, Maegawa J. Use of a dial tension gauge to assess quantitatively the intraoperative improvement of ocular movement after endoscopic transantral repair of fracture of the orbital floor. Br J Oral Maxillofac Surg 2012; 51:e135-6. [PMID: 22580011 DOI: 10.1016/j.bjoms.2012.04.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/21/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
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Transzygomatic Kirschner wire fixation for the treatment of blowout fracture. J Plast Reconstr Aesthet Surg 2012; 65:875-82. [PMID: 22373828 DOI: 10.1016/j.bjps.2012.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/15/2011] [Accepted: 01/23/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary. METHODS Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases. RESULTS Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek. CONCLUSIONS Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.
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Bae SH, Kang KD, Nam SB, Bae YC, Choi SJ. Orbital Floor Reconstruction through Endoscopic Transnasal Approach Alone. Arch Craniofac Surg 2012. [DOI: 10.7181/acfs.2012.13.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seong Hwan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Kyung Dong Kang
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Su Bong Nam
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soo Jong Choi
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
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T Tang D, F Lalonde J, H Lalonde D. Delayed Immediate Surgery for Orbital Floor Fractures: Less Can Be More. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011. [DOI: 10.1177/229255031101900402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Orbital floor fractures can result in diplopia, enophthalmos, hypoglobus and infraorbital dysthesia. Currently, the most common treatment for orbital floor fractures is immediate surgical intervention. However, there are a number of well-documented cases of unoperated orbital floor fractures in the literature, culminating in diplopia or enophthalmos in few patients. of these, none reported the diplopia or enophthalmos to be bothersome. As reported previously in the ophthalmology literature, most orbital floor fracture-induced diplopia resolves as the swelling settles, and the few patients with remaining diplopia can successfully be treated with surgery on the uninvolved eye. It has also been commented that most patients with enophthalmos are asymptomatic. The authors’ institution has more than 50 surgeon-years experience with delaying immediate surgery for two weeks to allow time for the swelling-induced diplopia to resolve. In the authors’ experience, true entrapment of the inferior rectus muscle is rare. The present article describes a study of late follow-up (average 945 days) of 11 nonoperated patients with orbital floor fractures. In the eight patients who initially presented with diplopia, there was resolution of functionally limiting double vision. Only one patient had asymptomatic, but measurably significant, enophthalmos at −3 mm. All patients had full restoration of extraocular movements and resolution of infraorbital dysthesia. None of the patients were exposed to the operative risks of ectropion, infection, implant extrusion, bleeding or blindness. The present study provides level IV evidence that delaying surgery up to two weeks after orbital floor fracture may avoid unnecessary surgical risks and inconveniences in many patients with orbital floor fracture.
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Affiliation(s)
- David T Tang
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
| | - Jan F Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
| | - Donald H Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
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