1
|
Takabayashi K, Maeda Y, Kataoka N. An innovative reconstruction procedure for fractures extending to the posterior orbital floor: utilizing the inferior margin of the greater wing of the sphenoid bone for reconstruction. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08808-5. [PMID: 39085473 DOI: 10.1007/s00405-024-08808-5] [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: 04/16/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE No definitive procedures have been proposed for orbital floor fractures extending to the slope of the posterior end, which is a challenging problem. This study demonstrates the effectiveness of an orbital reconstruction procedure based on anatomical landmarks that we developed, called the three landmarks procedure (TLP). METHODS This study is a single-center retrospective cohort study conducted by the Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital. Data were collected from April 2000 to December 2023. The effect of TLP and the balloon procedure (BP) on ocular movement was compared. The prevalence of postoperative enophthalmos after TLP was examined. RESULTS The study included 17 patients who underwent TLP and 25 patients who underwent BP. Postoperative mean Hess area ratio (HAR%) was 98.3 (95% confidence interval (CI), 97.0-99.6) in the TLP group and 88.6 (95% CI 83.2-94.0) in the BP group. Among study patients with fractures extending to the posterior slope, 14 underwent TLP and 16 underwent BP. Postoperative mean HAR% was 98.5 (95% CI 97.3-99.7) in the TLP group and 89.2 (95% CI 82.4-95.8) in the BP group. Among all patients who underwent TLP, mean postoperative enophthalmos was 0.06 mm (95% CI - 0.32 to 0.44). It was 0.14 mm (95% CI - 0.31 to 0.59) among patients with fractures extending to the posterior slope. CONCLUSION TLP resulted in better postoperative ocular movements than BP. Furthermore, TLP is an effective technique for treating fractures extending to the posterior slope, which are challenging to reconstruct.
Collapse
Affiliation(s)
- Kosuke Takabayashi
- Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital, Asahikawa City, Hokkaido, Japan
- Department of Otorhinolaryngology, Sapporo Medical University School of Medicine, Sapporo City, Hokkaido, Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka, 553-0003, Japan.
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
| | - Nobuya Kataoka
- Department of Ophthalmology, Japanese Red Cross Asahikawa Hospital, Asahikawa City , Hokkaido, Japan
| |
Collapse
|
2
|
[Options for reconstruction after injuries in the head and neck region]. HNO 2023; 71:57-62. [PMID: 36260106 DOI: 10.1007/s00106-022-01230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/18/2023]
Abstract
Reconstruction of lesions in the head and neck region must be both functionally and esthetically adequate, as the exposed anatomic position can easily lead to social stigmatization after injury. Distortion of symmetry, e.g., by a crooked nose, enophthalmos, or a (partial) amputation of the outer ear, is easily visible. On the other hand, limitations to nasal breathing and olfaction or diplopia may significantly reduce quality of life, and restoration of form and function continues to be challenging. This review discusses the treatment options for trauma of the external nose and the lateral midface, including the orbital floor and the auricle.
Collapse
|
3
|
Salli MI, Nikunen M, Snäll J. Primary reconstruction of extensive orbital fractures using two-piece patient-specific implants: the Helsinki protocol. Oral Maxillofac Surg 2022:10.1007/s10006-022-01065-y. [PMID: 35585440 DOI: 10.1007/s10006-022-01065-y] [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: 08/01/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants. METHODS We included all patients with primary reconstructions (< 22 days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5 mm or more; defect size more than a third of both inferior and medial walls; and Jaquiéry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups. RESULTS Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4/5 patients with two-piece PSIs and 2/14 with commercial implants. Revision surgery, globe malposition (GMP) > 2 mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms. CONCLUSION Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.
Collapse
Affiliation(s)
- Malla I Salli
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland.
| | - Matti Nikunen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland
| |
Collapse
|
4
|
Takabayashi K, Maeda Y, Kataoka N. Modified procedure for reconstructing the inferior wall of the orbit: identification of a reliable new landmark. Eur Arch Otorhinolaryngol 2022; 279:5955-5961. [PMID: 35951106 PMCID: PMC9649519 DOI: 10.1007/s00405-022-07587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/01/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND In orbital floor reconstruction, fractures involving the slope of the posterior end of the orbital floor make it difficult to determine the best location for implant placement. Therefore, landmarks for reconstruction are desirable to perform safe and reproducible reconstruction surgery. METHODS We developed a surgical procedure that focuses on three orbital landmarks: the infraorbital nerve, the inferior margin of the greater wing of the sphenoid bone, and the posterior superior wall of the maxilla. CONCLUSIONS Landmark-based orbital floor fracture reconstruction enables accurate reconstruction of fractures that extend to the slope of the posterior end of the orbital floor.
Collapse
Affiliation(s)
- Kosuke Takabayashi
- Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital, Asahikawa City, Hokkaido Japan
| | - Yohei Maeda
- Department of Otorhinolaryngology–Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City, Osaka 565-0871 Japan ,Department of Otorhinolaryngology, Japan Community Health Care Organization Osaka Hospital, Osaka City, Osaka Japan
| | - Nobuya Kataoka
- Department of Ophthalmology, Japanese Red Cross Asahikawa Hospital, Asahikawa City, Hokkaido Japan
| |
Collapse
|
5
|
Effective Reduction of Orbital Floor Fracture With Customized Balloon Using Contrast Agent And Micro Saw. J Craniofac Surg 2021; 32:1540-1544. [PMID: 33229994 DOI: 10.1097/scs.0000000000007249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The purpose of this article is to introduce simple, minimally invasive, more effective, and more comfortable method using a customized balloon with contrast agent for orbital floor fracture. The customized balloon was fabricated to compensate for its shortcomings, based on the experiences from four patients who underwent the surgery of orbital floor fracture using a Foley catheter.In a 33-year-old female patient with only orbital floor fracture, the reduction was performed using a transmaxillary approach with a customized balloon. The customized balloon was made using latex glove and 6 French gavage tube, and the contrast agent was injected within the balloon. A micro saw was used to form a window on the anterior wall of the maxillary sinus. Compared to the round bur, a micro saw can create an internal bevel along with minimal bone removal, which makes it possible to insert the bone fragment tightly without falling into the maxillary sinus when the fragment is repositioned. The use of contrast agent makes it more visible to determine the position of the balloon instantly during surgery by take portable radiograph. The balloon has removed after 3 weeks and no diplopia or no enophthalmos was observed. There remained very small defect on the anterior sinus wall about the size of gavage tube.The transmaxillary approach, along with a conjunctival or subciliary approach, can be a good choice for the treatment of orbital fractures. Compared to the conventional Foley catheter, the application of a customized balloon and contrast agent supports the entire orbital floor evenly and wide, and fills the maxillary sinus without an empty space. It is easy to check the location of the balloon through x-ray photography during surgery, and has a very little discomfort for the patient.
Collapse
|
6
|
Hwang W, Kim JW. Reconstruction of extended orbital floor fracture using an implantation method of gamma-shaped porous polyethylene. Arch Craniofac Surg 2019; 20:164-169. [PMID: 31256552 PMCID: PMC6615423 DOI: 10.7181/acfs.2019.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The conventional surgical method for reconstructing orbital floor fractures involves restoration of orbital continuity by covering an onlay with a thin material under the periorbital region. However, in large orbital floor fractures, the implant after inserting is often dislocated, leading to malposition. This study aimed to propose a novel implanting method and compare it with existing methods. METHODS Among patients who underwent surgery for large orbital floor fractures, 24 who underwent the conventional onlay implanting method were compared with 21 who underwent the novel γ implanting method that two implant sheets were stacked and bent to resemble the shape of the Greek alphabet γ. When inserting a γ-shaped implant, the posterior ledge of the orbital floor was placed between the two sheets and the bottom sheet was impacted onto the posterior wall of the maxilla to play a fixative role while the top sheet was placed above the residual orbital floor to support orbital contents. Wilcoxon signed-rank test and Mann-Whitney U test were used for data analyses. RESULTS Compared to the conventional onlay method, the gamma method resulted in better restoration of orbital contents, better improvement of enophthalmos, and fewer revision surgeries. CONCLUSION Achieving good surgical outcomes for extended orbital floor fractures is known to be difficult. However, better surgical outcomes could be obtained by using the novel implantation method of impacting a γ-shaped porous polyethylene posteriorly.
Collapse
Affiliation(s)
- Woosuk Hwang
- Department of Plastic and Reconstructive Surgery, Inje University School of Medicine, Busan, Korea
| | - Jin Woo Kim
- Department of Plastic and Reconstructive Surgery, Inje University School of Medicine, Busan, Korea
| |
Collapse
|
7
|
Li L, London NR, Silva S, Prevedello D, Carrau RL. Transnasal prelacrimal approach to the inferior intraconal space: a feasibility study. Int Forum Allergy Rhinol 2019; 9:1063-1068. [PMID: 31261443 DOI: 10.1002/alr.22368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endonasal access to the inferomedial and inferolateral intraconal space via the orbital floor has not been reported. The primary purpose of this study was to assess the feasibility of accessing the inferior intraconal space through the orbital floor via a transnasal prelacrimal approach. Secondarily, it aims to highlight anatomical relationships of neurovascular structures in this space, as a requirement to prevent complications. METHODS Six cadaveric heads (12 sides) were dissected using a transnasal prelacrimal approach. The orbital floor, medial to the infraorbital canal, was removed and the periorbita opened to expose the inferior rectus muscle. The inferomedial and inferolateral intraconal space was accessed alongside the medial and lateral border of inferior rectus muscle, respectively. Various anatomical relationships of adjacent neurovascular structures were recorded, and the distances among the recti muscles and optic nerve were also measured. RESULTS The infraorbital nerve is located at the inferolateral aspect of inferior rectus muscle. In the inferomedial intraconal space, we identified the inferomedial muscular trunk of the ophthalmic artery, optic nerve, and branches of the oculomotor nerve; whereas the inferolateral intraconal space contained the inferolateral muscular trunk of ophthalmic artery, branches of the oculomotor and nasociliary nerve, and abducens nerve. Distances from the medial, inferior, and lateral recti muscles to the optic nerve were (mean ± standard deviation) 4.70 ± 1.18 mm, 5.60 ± 0.93 mm, and 7.98 ± 1.99 mm, respectively. Distances from the inferior rectus muscle to the inferior borders of medial and lateral recti muscles were 4.45 ± 1.23 mm and 8.77 ± 1.80 mm. CONCLUSION It is feasible to access the inferior intraconal space through the orbital floor via a transnasal prelacrimal approach. The access may be subdivided into inferomedial and inferolateral corridors according to the entry point at the medial or lateral border of the inferior rectus muscle. Neurovascular structures in the inferior intraconal space are visualized directly, which should enhance their preservation.
Collapse
Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.,National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD
| | - Samuel Silva
- Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH
| | - Daniel Prevedello
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH.,Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH.,Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH
| |
Collapse
|
8
|
Said M, Gill AS, Strong EB. Utility of Endoscope-Assisted Orbital Fracture Repair for Atraumatic Reduction of Entrapped Muscle Tissue and Surgical Education. J Oral Maxillofac Surg 2019; 77:2298-2301. [PMID: 31153938 DOI: 10.1016/j.joms.2019.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
Trapdoor fractures can result in extraocular muscle entrapment with resultant pain, diplopia, bradycardia, nausea, and vomiting. Urgent repair is required to minimize the risk of permanent muscle injury and long-term diplopia. Complete fracture visualization is imperative to ensure adequate reduction of the herniated tissue and accurate implant placement when necessary. Orbital floor angulation and prolapsed orbital fat can make visualization of the posterior orbit challenging. Inadequate reduction can lead to reoperation in up to 18% of cases. Because the narrow field of view makes visualization difficult, teaching the surgical technique can be very challenging. We demonstrate the reduction of an entrapped inferior rectus muscle using an endoscope-assisted transconjunctival approach, highlighting its advantages in fracture visualization and surgical training.
Collapse
Affiliation(s)
- Mena Said
- Medical Student, Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, School of Medicine, Sacramento, CA
| | - Amarbir S Gill
- Resident, Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, School of Medicine, Sacramento, CA
| | - E Bradley Strong
- Professor, Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, School of Medicine, Sacramento, CA.
| |
Collapse
|
9
|
Park J, Baek S. Management of pediatric orbital wall fractures. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2018.1560266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|