Blowout Fracture in a 3-Year-Old
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Abstract:
A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed.Keywords:
Enophthalmos
Presentation (obstetrics)
Orbital Fracture
Case presentation
Conservative Treatment
A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed.
Enophthalmos
Presentation (obstetrics)
Orbital Fracture
Case presentation
Conservative Treatment
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복시가 동반된 안와골절 환자의 임상양상 강효정⋅하명숙 건양대학교 의과대학 안과학교실 목적: 복시가 동반된 안와골절 환자에서의 수술적 치료와 보존적 치료를 시행한 경우의 임상양상을 각각 분석하고자 한다
Enophthalmos
Conservative Treatment
Orbital Fracture
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Background and Objective: To compare early and late surgical repair of orbital blowout floor fractures. Patients and Methods: A retrospective, comparative interventional case series reviewed medical records of 50 consecutive patients who underwent unilateral orbital floor fracture repair in a 4-year period. Comparative analysis was performed between patients operated on within 2 weeks of injury and those operated on at a later stage. Results: Assault, motor vehicle accidents, and sports injuries were the most common causes of injury. Surgery was performed due to inferior rectus muscle entrapment and limitations in up gaze in 20 (40%) patients or to prevent enophthalmos in cases with sig nificant bony orbital expansion in 30 (60%) patients. After surgery, enophthalmos improved an average of 0.8 mm. Limitation in ocular motility improved after surgery but was statistically significant only in up gaze. Patients who underwent early repair (within 2 weeks) achieved less improvement in enophthalmos versus patients who underwent late repair (delta enophthalmos of 0.2 ± 1.1 vs 1.3 ± 1.9 mm, respectively; P = .02). Conclusion: In these patients, postoperative vertical ductions and postoperative enophthalmos improved after fracture repair. Surgery was associated with a low rate of postoperative complications. No apparent difference in surgical outcome was seen between early (within 2 weeks) and late surgical repair. [Ophthalmic Surg Lasers Imaging 2009;40:141–148.]
Orbital Fracture
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[Objective] To investigate clinical Characteristics and selection of the treatments of orbital fractures.[Methods] One hundred and six cases with orbital fracture treated by conservative or surgical treatments were reviewed and summarized.[Results] Twenty-four patients with reconstructive surgeries for orbital fractures were respectively analyzed,and their enophthalmos and diplopia were cured.In 82 conservative treated patients,there were 80 patients cured completely,except for 2 patients who should be treated with,but refused the surgery.[Conclusion] The operative indication is according to the existence of enophthalmos and/or diplopia.The combination of conservative treatment with surgery can obtain good curative effect.
Enophthalmos
Conservative Treatment
Orbital Fracture
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Objective: To evaluate the endoscopic transantral insertion of antral bone grafts into the orbit for repair of orbital floor defects.Design: A retrospective analysis with a mean follow-up of 5.3 months.Patients: Eleven patients who underwent surgical repair of orbital floor fractures.Setting: Municipal hospital.Main Outcome Measures: Preoperative and postoperative Hess screen tests and the presence of diplopia, enophthalmos, donor site complications, cosmetic deformity, infection, and graft extrusion.Results: Subjectively, 3 patients with diplopia had complete resolution of their symptoms after surgery, and 8 patients had improvement of their symptoms.Objectively, 11 patients had significant improvement in the postoperative Hess area ratio compared with the preoperative Hess area ratio.In 1 patient with a floor defect measuring 2.5 cm, enophthalmos existed after surgery, but reoperation was not performed in this case because diplopia was improved.There were no donor site complications, cosmetic deformity, infection, or graft extrusion.
Enophthalmos
Orbit (dynamics)
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Abstract Enophthalmos caused by orbital volume expansion is the traditional indication for blowout fracture operation, but it may not appear immediately after orbital trauma due to periorbital swelling. The purpose of this study was to investigate the correlations of the orbital volume ratio (OVR) and, orbital fracture area (OFA) with the late enophthalmos measurement in unilateral pure blowout fracture. Seventy-two patients who had experienced a blowout fracture were divided into 2 groups, the conservative treatment group (n = 40) and the operative treatment group (n = 32). The authors measured the preoperative OVR and OFA using three-dimensional facial bone computed tomography and investigated their relationship with late enophthalmos that obtained 6 months after orbital trauma. In both conservative and operative groups, there were significant positive correlations between the OVR and OFA ( P < 0.05). In the conservative group, both the OVR and OFA showed significant positive correlations with late enophthalmos, but the OVR ( r = 0.777) was more closely correlated with enophthalmos than the OFA ( r = 0.739). Quantitative measurements of OVR and OFA are useful parameters that can predict the extent of late enophthalmos and are useful in planning the treatment of blowout fracture.
Enophthalmos
Orbital Fracture
Conservative Treatment
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This study evaluates the usefulness of endoscopic repair compared to external repair in the treatment of blowout fracture (BOF) of the orbit.This retrospective study comprised 100 patients who had had surgical repair of orbital BOF since 1992. Forty-eight of the 100 had undergone endoscopic repair, 48 patients had had external repair, and four patients underwent surgery that combined the two approaches. The two basic approaches were evaluated and compared with respect to technique, results and complications.Endoscopically, transnasal and transantral approaches had been used for reduction and support of fractured medial and inferior walls, respectively. In the external approach, various transorbital incisions were made and the fractured wall was repaired with alloplastic or autologous materials. Complete or partial resolution of preoperative diplopia was achieved in 94% of the endoscopic group and 83% of the external group (NS). Enophthalmos was improved in 89% of the endoscopic group and 76% of the external group (NS). Though the endoscopic group had no significant complications, the external group had ectropions, significant facial scars, extrusion of inserted Medpor, and intra-orbital hematoma.Endoscopic repair appears to be a safe and effective technique for the treatment of BOF of the orbit.
Enophthalmos
Orbit (dynamics)
Orbital Fracture
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Objective: The clinical features of orbital blowout fracture were analysed and evaluate efficacy of the operation. Methods: The plastic operations on 44 patients with blowout orbital fractures were reviewed and studied. Results: On discharg from the hospital, enophthalmos was corrected in all cases (100%), diplopia disappeared in 20 cases (52. 6%) and relieved in 16 cases (42.1%). conclusion: In patients with orbital blowout fracture, if there is no improvement of diplopia or enophthalmos is obvious after two weeks of conservative treatment, surgery is the only effective method that could obtain satisfactory result.
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Orbital Fracture
Conservative Treatment
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BACKGROUND AND OBJECTIVES: Before introducing transnasal endoscopic sinus surgery, surgical repair of the blowout fracture includes the transorbital approach with an external incision and/or the maxilloethmoidal approach. The advantages of the transnasal endoscopic technique include magnified direct visualization and easy access to the medial orbital walls. Gelfoam is a slowly absorbable material and is rigid enough to provide support where Silastic sheet is to be placed. The purpose of this study was to evaluate outcomes of transnasal endoscopic reconstruction with Gelfoam and Silastic sheet of medial orbital wall fracture. SUBJECTS AND METHOD: This study was a retrospective analysis 27 patients who underwent transnasal endoscopic reduction of blowout fracture from February 1999 to April 2004. The follow-up period was at least over than 12 months. RESULTS: The study population included 18 males and 9 female patients ranging from 13 to 54 years (mean, 33.3 years) of age. Twenty of 23 patients with diplopia showed a complete improvement of diplopia and 3 patients showed an incomplete improvement. All of 13 patients with limitation of ocular movement and 2 patients with enophthalmos revealed a complete resolution of their symptoms. There were no significant complications in all patients although ocular pain and epiphora were observed temporally after operation. CONCLUSION: Transnasal endoscopic reconstruction with Gelfoam and Silastic sheet for medial orbital wall fracture is a very successful technique that does not accompany major complications and has definite cosmetic advantage of causing no external scarring
Silastic
Enophthalmos
Medial wall
Orbital Fracture
Orbit (dynamics)
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Purpose To search for complications of orbital floor fracture repair that occur late postoperatively, to reveal their natural course and to attempt to associate the complications with variables that are possibly involved in their genesis. Methods A retrospective comparative case series of all orbital floor fracture repair cases (158 eyes) from 1983 to 1998 was done. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction (eg, sinus) was required. Variables studied included age, sex, trauma to surgery time lag, surgeon, fracture type, length of surgery, antibiotics, prosthesis material, hospital stay and follow-up. These variables were tested for association with the following complications: altered vision, diplopia, dysesthesia, ectropion, pain, infection, enophthalmos and extrusion. Occurrence and resolution data were collected. Results One of four complications (often more than one per eye) resolved without surgery. Reintervention resolved one of three complications. Of all patients, 39.2% remain with long term unresolved complications. Altered vision is more probable with older patients and with longer surgeries. Diplopia was least likely to occur with orbitozygomatic or panfacial fractures and more probable with bone grafts. Ectropion and epiphora increased with a fracture's severity. Pain was mostly attributable to bone grafts. Enophthalmos was mainly due to large or comminuted fractures. Infection and extrusion were rare. Sex, surgeon and trauma to surgery time lag had no bearing on the incidence of complications. Conclusions Delaying surgery did not seem to influence complications. Lessening ocular manipulation during longer surgeries may reduce vision changes. The only truly modifiable variable was the material used for orbital floor repair. Alloplastic prostheses should be used, but if large or comminuted fractures are involved, bone grafting is an interesting first choice.
Enophthalmos
Orbital Fracture
Ectropion
Chemosis
Orbit (dynamics)
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