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Moris V, Cousin A, Chauvel-Picard J, Lange E, Bourlet J, Zwetyenga N, Gleizal A. Long-term enophthalmos after complex orbital bone loss successfully treated with patient-specific porous titanium implants: A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:102019. [PMID: 39182846 DOI: 10.1016/j.jormas.2024.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Long-term enophthalmos and diplopia resulting from orbital bone loss pose significant challenges in reconstructive surgery. This study evaluated the effectiveness of patient-specific porous titanium implants (PSIs) for addressing these conditions. MATERIALS AND METHODS This retrospective study involved 12 patients treated at Croix-Rousse Hospital, Lyon, from April 2015 to April 2022 who underwent late reconstruction via PSI for unilateral complex orbital bone loss. These implants were customized via 3D mirroring techniques on the basis of high-resolution computed tomography (CT) scans of the patients' unaffected orbits. RESULTS All 12 patients presented with significant preoperative enophthalmos, with an average displacement of 3.24 mm, which was effectively corrected postoperatively to an average of 0.17 mm (p < 0.001). Orbital volume notably improved from a preoperative average of 3.38 mL to 0.37 mL postsurgery (p < 0.001). Functional improvements were evident as both enophthalmos and diplopia resolved completely. The Lancaster test revealed an improvement in the visual field, with 83.3 % of patients achieving normal results postoperatively. DISCUSSION By ensuring anatomical accuracy, patient-specific porous titanium implants, tailored from patient-specific imaging and fabricated via advanced 3D printing technology, provide a precise, effective, and reliable solution for reconstructing complex orbital defects and performing complicated revision surgeries.
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Affiliation(s)
- Vivien Moris
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France.
| | - Anthony Cousin
- Service de chirurgie Maxillo-faciale, Centre hospitalier de Semur en Auxois, 3 avenue pasteur, 21140 Semur-en-Auxois, France.
| | - Julie Chauvel-Picard
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France, Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Edouard Lange
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France, Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
| | - Jérôme Bourlet
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France, Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
| | - Narcisse Zwetyenga
- Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, chirurgie de la main, CHU de Dijon, boulevard de Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France, Lipids Nutrition Cancer team NuTox UMR866, université de Bourgogne Franche-Comté, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Arnaud Gleizal
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France, Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.
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Kontio R, Wilkman T, Mesimäki K, Chepurnyi Y, Asikainen A, Haapanen A, Poutala A, Mikkonen M, Slobodianiuk A, Kopchak A. Automated 3-D Computer-Aided Measurement of the Bony Orbit: Evaluation of Correlations among Volume, Depth, and Surface Area. J Pers Med 2024; 14:508. [PMID: 38793092 PMCID: PMC11122174 DOI: 10.3390/jpm14050508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
(1)The study aimed to measure the depth, volume, and surface area of the intact human orbit by applying an automated method of CT segmentation and to evaluate correlations among depth, volume, and surface area. Additionally, the relative increases in volume and surface area in proportion to the diagonal of the orbit were assessed. (2) CT data from 174 patients were analyzed. A ball-shaped mesh consisting of tetrahedral elements was inserted inside orbits until it encountered the bony boundaries. Orbital volume, area depth, and their correlations were measured. For the validation, an ICC was used. (3) The differences between genders were significant (p < 10-7) but there were no differences between sides. When comparing orbit from larger to smaller, a paired sample t-test indicated a significant difference in groups (p < 10-10). A simple linear model (Volume~1 + Gender + Depth + Gender:Depth) revealed that only depth had a significant effect on volume (p < 10-19). The ICCs were 1.0. (4) Orbital volume, depth, and surface area measurements based on an automated CT segmentation algorithm demonstrated high repeatability and reliability. Male orbits were always larger on average by 14%. There were no differences between the sides. The volume and surface area ratio did not differ between genders and was approximately 0.75.
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Affiliation(s)
- Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
- Institute of Oral and Maxillofacial Diseases, Helsinki University, 00014 Helsinki, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Yurii Chepurnyi
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Antti Asikainen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, 00290 Helsinki, Finland; (R.K.); (T.W.); (K.M.); (A.A.); (A.H.)
| | - Arto Poutala
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Marko Mikkonen
- Disior, Maria 01, Building 2, Lapinlahdenkatu 16, 00180 Helsinki, Finland; (A.P.); (M.M.)
| | - Alina Slobodianiuk
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
| | - Andrii Kopchak
- Department of Maxillofacial Surgery and Modern Dental Technologies, O.O.Bogomolets Medical University, 02000 Kyiv, Ukraine; (Y.C.); (A.K.)
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Khani H, Fazelinejad Z, Hanafi MG, Mahdianrad A, Eftekhari-Moghadam AR. Morphometric and volumetric evaluations of orbit using three-dimensional computed tomography in southwestern Iranian population. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Lee KS, Do GC, Shin JB, Kim MH, Kim JS, Kim NG. One-point versus two-point fixation in the management of zygoma complex fractures. Arch Craniofac Surg 2022; 23:171-177. [PMID: 36068692 PMCID: PMC9449097 DOI: 10.7181/acfs.2022.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The treatment of zygoma complex fractures is of crucial importance in the field of plastic surgery. However, surgical methods to correct zygoma complex fractures, including the number of fixation sites, differ among operators. Although several studies have compared two-point and three-point fixation, no comparative research has yet been conducted on one-point versus two-point fixation using computed tomography scans of surgical results. Therefore, the present study aimed to address this gap in the literature by comparing surgical results between one-point and two-point fixation procedures. Methods In this study, we randomly selected patients to undergo surgery using one of two surgical methods. We analyzed patients with unilateral zygoma complex fractures unaccompanied by other fractures according to whether they underwent one-point fixation of the zygomaticomaxillary buttress or two-point fixation of the zygomaticomaxillary buttress and the zygomaticofrontal suture. We then made measurements at three points—the zygomaticofrontal suture, inferior orbital wall, and malar height—using 3-month postoperative computed tomography images and performed statistical analyses to compare the results of the two methods. Results All three measurements (zygomaticofrontal suture, inferior orbital wall, and malar height) showed significant differences (p<0.05) between one-point and two-point fixation. Highly significant differences were found for the zygomaticofrontal suture and malar height parameters. The difference in the inferior wall measurements was less meaningful, even though it also reached statistical significance. Conclusion Using three parameters in a statistical analysis of imaging findings, this study demonstrated significant differences in treatment outcomes according to the number of fixations. The results indicate that bone alignment and continuity can be achieved to a greater extent by two-point fixation instead of one-point fixation.
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Affiliation(s)
- Kyung Suk Lee
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gi Cheol Do
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Bong Shin
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Hyung Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jun Sik Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nam Gyun Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Hierl KV, Krause M, Kruber D, Sterker I. 3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex. PLoS One 2022; 17:e0265324. [PMID: 35275980 PMCID: PMC8916626 DOI: 10.1371/journal.pone.0265324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.
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Affiliation(s)
| | - Matthias Krause
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Daniel Kruber
- Department of Informatics and Media, Leipzig University of Applied Sciences, Leipzig, Germany
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University, Leipzig, Germany
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Ma CY, Wang TH, Yu WC, Shih YC, Lin CH, Perng CK, Ma H, Wang SJ, Chen WM, Chen CE. Accuracy of the Application of 3-Dimensional Printing Models in Orbital Blowout Fractures-A Preliminary Study. Ann Plast Surg 2022; 88:S33-S38. [PMID: 35225846 DOI: 10.1097/sap.0000000000003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Application of 3-dimensional (3D) printing technology has grown in the medical field over the past 2 decades. In managing orbital blowout fractures, 3D printed models can be used as intraoperative navigators and could shorten the operational time by facilitating prebending or shaping of the mesh preoperatively. However, a comparison of the accuracy of computed tomography (CT) images and printed 3D models is lacking. MATERIAL AND METHODS This is a single-center retrospective study. Patients with unilateral orbital blowout fracture and signed up for customized 3D printing model were included. Reference points for the 2D distance were defined (intersupraorbital notch distance, transverse horizontal, sagittal vertical, and anteroposterior axes for orbital cavity) and measured directly on 3D printing models and on corresponding CT images. The difference and correlation analysis were conducted. RESULTS In total, 9 patients were reviewed from June 2017 to December 2020. The mean difference in the intersupraorbital notch measurement between the 2 modules was -0.14 mm (P = 0.67). The mean difference in the distance measured from the modules in the horizontal, vertical, and anteroposterior axes of the traumatic orbits was 0.06 mm (P = 0.85), -0.23 mm (P = 0.47), and 0.51 mm (P = 0.32), whereas that of the unaffected orbits was 0.16 mm (P = 0.44), 0.34 mm (P = 0.24), and 0.1 mm (P = 0.88), respectively. Although 2D parameter differences (<1 mm) between 3D printing models and CT images were discovered, they were not statistically significant. CONCLUSIONS Three-dimensional printing models showed high identity and correlation to CT image. Therefore, personalized models might be a reliable tool of virtual surgery or as a guide in realistic surgical scenarios for orbital blowout fractures.
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Affiliation(s)
- Chun-Yu Ma
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital
| | | | - Wen-Chan Yu
- Rehabilitation and Technical Aids Center, Taipei Veterans General Hospital
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Chan MA, Ibrahim F, Kumaran A, Yong K, Chan ASY, Shen S. Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery. BMC Ophthalmol 2021; 21:290. [PMID: 34325667 PMCID: PMC8320059 DOI: 10.1186/s12886-021-02009-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.
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Affiliation(s)
| | | | | | - Kailing Yong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Anita Sook Yee Chan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Sunny Shen
- Singapore National Eye Centre, Singapore, Singapore. .,Singapore Eye Research Institute, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore.
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Engin Ӧ, Adriaensen GFJPM, Hoefnagels FWA, Saeed P. A systematic review of the surgical anatomy of the orbital apex. Surg Radiol Anat 2021; 43:169-178. [PMID: 33128648 PMCID: PMC7843489 DOI: 10.1007/s00276-020-02573-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The orbital apex is the narrowest part of the orbit, housing the link between the intracranial cavity and orbit. Knowledge of orbital apex anatomy is crucial to selecting a surgical approach and reducing the risk of complications. Our purpose is to summarize current knowledge on surgical anatomy and attempt to reach a consensus on definition of the orbital apex. METHODS The online databases of Embase, the Cochrane library, Web of Science and PubMed (MEDLINE) were queried in a comprehensive bibliographic search on the (surgical) anatomy of the orbital apex and consisted of a combination of two subjects, using indexed terms and free text: "Orbital Apex" and "Orbital Anatomy." RESULTS A total of 114 relevant papers were included in this review. Numerous anatomical variations are described in the literature. Variations of the optic canal include duplication (0.64%) and keyhole anomaly (2.65%). Variations in pneumatization of the anterior clinoid process were unilateral in almost 10%, bilateral in 9%, and normal in 72%. A rare variant of the superior orbital fissure (SOF) is Warwick's foramen, which appears as if the lowest portion of the SOF was separated from the main fissure by a transverse bony bridge. CONCLUSION The definition of the orbital apex varies in the literature, and further research would most likely identify additional variations. A universal definition reporting these variations and pathology and imaging findings is essential for determining the optimal surgical approach to the orbital apex.
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Affiliation(s)
- Ӧ Engin
- Orbital Center, Ophthalmology Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
| | - G F J P M Adriaensen
- Orbital Center, Ophthalmology Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Otorhinolaryngology Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - F W A Hoefnagels
- Orbital Center, Ophthalmology Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Neurosurgery Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - P Saeed
- Orbital Center, Ophthalmology Department, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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Anatomical and Volumetric Analysis of the Sphenoid Sinus by Semiautomatic Segmentation of Cone Beam Computed Tomography. J Craniofac Surg 2020; 32:1166-1170. [PMID: 33181613 DOI: 10.1097/scs.0000000000007209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This investigation was performed to analyze and evaluate anatomical and volumetric data of the sphenoid sinus by semiautomatic segmentation of cone beam computed tomography (CBCT) datasets.This analysis was carried out on cone beam computed tomography images of 100 patients. By using the discretionary software "ITK-Snap", the volumetric investigation of 197 sphenoid sinuses was conducted. The statistical analyses were carried out by using the paired and independent Student t-test. In addition, the Pearsons chi-square test was performed. P values P < 0.05 were considered significant.The volumetric mean was 4.438 ± 2.434 cm for the right and 4.809 ± 3.000 for the left side. Results did not indicate statistically significant differences according to the side, irrespective of gender (P > 0.05). The further investigation of differences between male and female patients did assess significant results (P < 0.05), males (10.477 ± 3.851 cm) present a larger total sinus volume than females (8.219 ± 3.574 cm). In accordance to patients' age (median 54 years), smaller volumes were related to younger patients and larger volumes to older ones. But, no statistically significant results in accordance to age could be detected (χ = 1.258; P > 0.05).Endoscopic sinus surgery of the vulnerable and intricate anatomy of the sphenoid sinus requires an explicit knowledge and orientation about the anatomical variations such as septums and volumetric capacity. Concerning this matter, semiautomatic segmentation of CBCT images can aid the surgeon in preoperative planning. Our investigation shows that a small sinus volume, that is, affecting female patients and a complex sinus anatomy by the occurrence of a septum, especially located close to neurovascular structures could essentially aggravate endoscopic sphenoid sinus surgery. In this regard, volumetric analysis of the sphenoid sinus by CBCT images can provide presurgical information and facilitates an individualized treatment.
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Moon SJ, Lee WJ, Roh TS, Baek W. Sex-related and racial variations in orbital floor anatomy. Arch Craniofac Surg 2020; 21:219-224. [PMID: 32867410 PMCID: PMC7463127 DOI: 10.7181/acfs.2020.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Repair of the orbital floor following trauma or tumor removal remains a challenge because of its complex three-dimensional shape. The purpose of the present study is to understand normal orbital floor anatomy by investigating its differences across four groups (Caucasian American and East Asian, males and females) via facial bone computed tomography (CT). METHODS A total of 48 orbits in 24 patients between 20 and 60 years of age were evaluated. Although most patients underwent CT scanning following trauma, the orbital walls were intact in all patients. Linear and angular measurements of the orbital floor were obtained from CT images. RESULTS Orbital floor width, length, angle between the orbital floor and medial wall, and distance from the inferior orbital rim to the lowest point of the orbital floor did not show a statistically significant difference between groups. Angles made by the infraorbital rim, the lowest point of the floor, and the anterior border of the infraorbital fissure were statistically significantly wider in East Asian females than in male groups. The floor depth in East Asian females was significantly smaller compared to all the other groups. CONCLUSION East Asian female population had smaller curvature and depth of an orbital floor than the other groups, which means racial and sex-related differences should be considered in the orbital floor reconstruction.
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Affiliation(s)
- Seung Jin Moon
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wooyeol Baek
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Correct anatomical reconstruction of the orbital wall for function and cosmesis is important; however, this is difficult because of the structure's complexity. The authors aimed to analyze and classify orbital morphology from computed tomography (CT) images and examine the relationship between orbital morphology and eyelid morphology in the Japanese population. CT images of 60 men (right side, 29; left side, 31) and 44 women (each side, 22) were included. The lengths of the orbital medial wall and floor in the coronal plane at the anterior, middle, and posterior planes of the orbit; angle between them; simotic index; and the thickness of upper eyelid were measured. Additionally, the presence or absence of double eyelids was evaluated. Non-paired Student's t test and Pearson correlation coefficient test were used for analysis. Orbital morphology was symmetrical on both sides, and men had a larger orbit than women. Orbital morphology was classified into 2 groups according to the posterior angle, and there was a difference between the groups in the simotic index. The difference between groups may represent a genetic difference between the Jomon and Yayoi people and not only provide a new classification for the orbit of the population but also be useful in orbital reconstruction.
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Abstract
PURPOSE To our knowledge, no prior study has measured bony orbital volume in a group of subjects over time. This study evaluates longitudinal changes in bony orbital volume with age. METHODS A search was created for patients with digitized CT imaging studies of the orbit at least 8 years apart. Charts with a history of prior head trauma, head and neck tumors, sinus disease, head surgery, elevated intracranial pressure, thyroid eye disease, or conditions that could affect bone metabolism were excluded. Three outcome measures were used: orbital volume, medial orbital wall length, and lateral orbital wall length. Categorical data were summarized with frequency (%); normally distributed continuous data are summarized with mean (standard deviation), and non-normally distributed data were summarized with median. Normality was verified with Shapiro-Wilk Test. Paired t-tests were used to analyze the differences in the 3 outcome variables. RESULTS One hundred and eighty-two subjects, 91 males and 91 females, were included. The median time between CT scans was 9.4 years. Orbital volume was significantly larger at the second scan than the first (p < 0.001). The average difference in orbital volume was 0.91 ml, an increase of 4.1%. Lateral orbital length was significantly shorter in the second scan than in the first (p = 0.046) though the difference was only 0.4 mm. There was no statistically significant change in medial orbital wall length. CONCLUSIONS Bony orbital volume increases in individuals with age. This increase in orbital volume occurs in the context of soft tissue changes to contribute to the aging appearance of the periorbital region.
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Planes of Reference for Orbital Fractures: A Technique for Reproducible Measurements of the Orbit on Computed Tomography Scans. J Craniofac Surg 2018; 29:1817-1820. [DOI: 10.1097/scs.0000000000005021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pedemonte C, Muñoz T, Valenzuela K, Díaz M, González LE, Vargas I. Reconstruction of medial orbital wall using a retrocaruncular approach. J Craniomaxillofac Surg 2018; 46:1726-1730. [PMID: 30170961 DOI: 10.1016/j.jcms.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/20/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
The purpose of the study was to analyze and describe the retrocaruncular approach to access medial orbital wall. A retrospective analysis was performed in patients referred for the treatment of orbital fractures between January 1st 2011 and July 31st 2017. The study included patients over 18 years old with isolated fractures of the medial orbital wall or combined with the orbital floor who underwent a transconjunctival approach with retrocaruncular extension and lateral canthotomy, and with a minimum follow-up of 6 months. Patients with fractures to the roof and/or lateral orbital wall were excluded. From a total of 319 orbits, 30 medial wall fractures were treated using a retrocaruncular approach, transconjunctival extension and lateral canthotomy. 7 of them were pure medial wall fractures and 23 were combined with orbital floor. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Only one patient developed a conjunctival granuloma in relation to the caruncle. No others patients had complications. This study concluded that this approach is a successful access for surgical treatment of medial orbital wall fractures because of their broad visibility without damaging structures, allowing adequate orbital reconstruction and excellent aesthetic results.
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Affiliation(s)
- Christian Pedemonte
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile.
| | - Tamara Muñoz
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile
| | - Katherine Valenzuela
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile
| | - Marlene Díaz
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile
| | - L Edgardo González
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile
| | - Ilich Vargas
- Department of Oral and Maxillofacial Surgery of the Hospital Clínico Mutual de Seguridad, Chile
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Açar G, Büyükmumcu M, Güler İ. Computed tomography based analysis of the lamina papyracea variations and morphology of the orbit concerning endoscopic surgical approaches. Braz J Otorhinolaryngol 2018; 85:551-559. [PMID: 29859679 PMCID: PMC9443057 DOI: 10.1016/j.bjorl.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/04/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Radiologic evaluation is mandatory to assess the type of endoscopic approach concerning sinonasal pathology and reconstruction of fractured defects before any treatment modalities are instituted related to medial wall of the orbit. Objective The goal was to provide improved understanding of the lamina papyracea variations and the relationship with the orbital morphometry. Methods This retrospective study was performed using computed tomography scans of 200 orbits and results were compared with respect to age, sex, laterality and LP variations. Results Lamina papyracea variations were categorized as type A, 80.5% (161/200); type B, 16% (32/200); type C, 3.5% (7/200). For medial wall the anterior and posterior lamina papyracea heights and angles were found as 17.14 mm, 147.88° and 9.6 mm, 152.72°, respectively. Also, the length of the lamina papyracea, the mean area of the orbital floor, medial wall, lamina papyracea and orbital entrance were 33.3 mm, 7.2 cm2, 6.89 cm2, 4.51 cm2 and 12.46 cm2 respectively. The orbital height and width were measured as 35.9 mm and 39.2 mm respectively. The mean orbital cavity depth was 46.3 mm from optic foramen to the orbital entrance and the orbital volume was 19.29 cm3. We analyzed the morphometric measurements tending to increase with aging and greater in men and the relationship of them with lamina papyracea types. Conclusion Precise knowledge of the lamina papyracea anatomy using computed tomography is essential for safer and more effective surgery and preforming the dimensions of an implant. In this way, the postoperative complications can be decreased and the best outcome can be provided.
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Affiliation(s)
- Gülay Açar
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anatomy, Konya, Turkey.
| | - Mustafa Büyükmumcu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anatomy, Konya, Turkey
| | - İbrahim Güler
- Selcuk University, Faculty of Medicine, Department of Radiology, Konya, Turkey
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