Combined Orbital Fractures: Surgical Strategy of Sequential Repair
Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of th...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2015-07-01
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| Series: | Archives of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2015.42.4.424 |
| _version_ | 1811303592472084480 |
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| author | Su Won Hur Sung Eun Kim Kyu Jin Chung Jun Ho Lee Tae Gon Kim Yong-Ha Kim |
| author_facet | Su Won Hur Sung Eun Kim Kyu Jin Chung Jun Ho Lee Tae Gon Kim Yong-Ha Kim |
| author_sort | Su Won Hur |
| collection | DOAJ |
| description | Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes.
Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant.
Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed.
Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon. |
| first_indexed | 2024-04-13T07:49:41Z |
| format | Article |
| id | doaj.art-f01f6be829644576b4d3b6396c905c82 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-13T07:49:41Z |
| publishDate | 2015-07-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-f01f6be829644576b4d3b6396c905c822022-12-22T02:55:34ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712015-07-01420442443010.5999/aps.2015.42.4.424532Combined Orbital Fractures: Surgical Strategy of Sequential RepairSu Won Hur0Sung Eun Kim1Kyu Jin Chung2Jun Ho Lee3Tae Gon Kim4Yong-Ha Kim5Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaDepartment of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaDepartment of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaDepartment of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaDepartment of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaDepartment of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, KoreaBackground Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2015.42.4.424orbital fracturesfractures, comminutedfacial bones |
| spellingShingle | Su Won Hur Sung Eun Kim Kyu Jin Chung Jun Ho Lee Tae Gon Kim Yong-Ha Kim Combined Orbital Fractures: Surgical Strategy of Sequential Repair Archives of Plastic Surgery orbital fractures fractures, comminuted facial bones |
| title | Combined Orbital Fractures: Surgical Strategy of Sequential Repair |
| title_full | Combined Orbital Fractures: Surgical Strategy of Sequential Repair |
| title_fullStr | Combined Orbital Fractures: Surgical Strategy of Sequential Repair |
| title_full_unstemmed | Combined Orbital Fractures: Surgical Strategy of Sequential Repair |
| title_short | Combined Orbital Fractures: Surgical Strategy of Sequential Repair |
| title_sort | combined orbital fractures surgical strategy of sequential repair |
| topic | orbital fractures fractures, comminuted facial bones |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2015.42.4.424 |
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