Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair

Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.

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Bioresorbable Material in Secondary Orbital Reconstruction Surgery

Journal of Ophthalmology ◽

10.1155/2019/8715314 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hui Pan ◽

Zhenzhen Zhang ◽

Weiwei Tang ◽

Zhengkang Li ◽

Yuan Deng

Keyword(s):

Retrospective Chart Review ◽

Fracture Repair ◽

Orbital Fracture ◽

Ocular Motility ◽

Orbital Fractures ◽

Orbital Reconstruction ◽

Primary Surgery ◽

Ocular Movement ◽

Bioresorbable Material ◽

Secondary Orbital Reconstruction

Purpose. To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods. A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients’ demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results. All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P<0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions. This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.

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Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520939032 ◽

2020 ◽

pp. 194338752093903

Author(s):

Sophia Seen ◽

Stephanie Young ◽

Stephanie S. Lang ◽

Thiam-Chye Lim ◽

Shantha Amrith ◽

...

Keyword(s):

Clinical Findings ◽

Fracture Repair ◽

Titanium Implants ◽

Medial Wall ◽

P Value ◽

Orbital Fracture ◽

Ocular Motility ◽

Orbital Reconstruction ◽

Alloplastic Materials ◽

Materials Used

Study Design: Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. Objective: To compare the outcomes of different implants used for various types of orbital fractures. Methods: Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. Results: There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% ( n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable ( n = 117, 38.1%) and prefabricated titanium plates ( n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia ( p-value < 0.001) 1 year following orbital fracture reconstruction. Conclusions: When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.

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New Extraocular Muscle Entrapment after Facial Fracture Repair

FACE ◽

10.1177/27325016211015404 ◽

2021 ◽

pp. 273250162110154

Author(s):

Lucas A. Dvoracek ◽

Jonathan Y. Lee ◽

S. Tonya Stefko ◽

Jesse A. Goldstein

Keyword(s):

Extraocular Muscle ◽

Rectus Muscle ◽

Fracture Repair ◽

Orbital Fracture ◽

Facial Fracture ◽

Inferior Rectus ◽

Orbital Floor Fracture ◽

Careful Assessment ◽

Inferior Rectus Muscle ◽

New Onset

Extraocular muscle entrapment is a well-recognized complication of orbital fracture, wherein the inferior rectus muscle becomes lodged within the fracture fragments at the time of the initial trauma. New onset entrapment cannot occur without new force applied to the orbit, displacing the fragments and the inferior rectus. Theoretically, in complex orbital fractures, manipulation of disjunct fragments may apply pressure to the orbital contents and induce new entrapment in an otherwise non-operative orbital floor fracture. Here we present the only described case of new extraocular muscle entrapment after open reduction and fixation of a supraorbital rim and frontal sinus fractures and emphasize the need for careful assessment after repair of such a fracture to ensure that new entrapment has not occurred.

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Two Cases of Combined Orbital Fractures Involving Medial Wall, Inferior Wall and Inferomedial Strut

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2015.58.8.580 ◽

2015 ◽

Vol 58 (8) ◽

pp. 580 ◽

Cited By ~ 1

Author(s):

Jae Hong Park ◽

Yun Seok Oh ◽

Woo Sub Shim ◽

Je Yeob Yeon

Keyword(s):

Medial Wall ◽

Inferior Wall ◽

Orbital Fractures

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Hypotony Without Globe Rupture During Orbital Fracture Repair

The Laryngoscope ◽

10.1002/lary.29583 ◽

2021 ◽

Author(s):

Yvette L. Schein ◽

Sana Ali Bautista ◽

Joanna Kam

Keyword(s):

Fracture Repair ◽

Orbital Fracture ◽

Globe Rupture

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Incidence and management of retrobulbar hemorrhage after blowout fracture repair

BMC Ophthalmology ◽

10.1186/s12886-021-01943-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jae Hwi Park ◽

Inhye Kim ◽

Jun Hyuk Son

Keyword(s):

Medical Center ◽

Rare Complication ◽

Fracture Repair ◽

Control Group ◽

Orbital Decompression ◽

Secondary Surgery ◽

Orbital Surgery ◽

Exact Test ◽

Blowout Fracture ◽

Retrobulbar Hemorrhage

Abstract Background Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to identify clinical characteristics of patients with RBH requiring emergent orbital decompression after blowout fracture repair. Method A retrospective review of 426 blowout fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in patient charts on a scale from 0 to − 4. Patients requiring emergent orbital decompression due to RBH after surgery (RBH group) were compared with those who did not (Control group), using the Mann-Whitney U-test. Incidences of RBH according to primary or secondary surgery were also investigated, using Fisher’s exact test. Result Five (1.2%) of the 426 patients who underwent blowout fracture repair developed RBH requiring emergent intervention. All RBH patients fully recovered after the decompression procedure or conservative treatment. Number of days to surgery was significantly longer in the RBH group (97.0 ± 80.1) than in the Control group (29.0 ± 253.0) (p = 0.05). Preoperative enophthalmos was also significantly greater in the RBH group (RBH vs. Control group, 3.6 ± 1.7 mm versus 1.2 ± 1.3 mm (p = 0.003)). The incidence of RBH was significantly higher in patients that underwent secondary surgery (odds ratio = 92.9 [95% confidence interval, 11.16–773.23], p = 0.001). Conclusions Surgeons should pay more attention to hemostasis and postoperative care in patients with a large preoperative enophthalmic eye, when time from injury to surgery is long and in revision cases. When RBH occurs, time to intervention and surgical decompression is critical for visual recovery and preventing blindness. Trial registration The institutional review board of the Yeungnam University Medical Center approved this study (YUMC 2018-11-010), which was conducted in accord with the Declaration of Helsinki.

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The Transcaruncular Approach to Orbital Fracture Repair

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e31803384c2 ◽

2007 ◽

Vol 18 (2) ◽

pp. 420-426 ◽

Cited By ~ 27

Author(s):

Raman Malhotra ◽

George M. Saleh ◽

Jean-Louis de Sousa ◽

Ken Sneddon ◽

Dinesh Selva

Keyword(s):

Fracture Repair ◽

Orbital Fracture

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Frequency of post-traumatic osteoarthritis in dogs after repair of a humeral condylar fracture

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632755 ◽

2003 ◽

Vol 16 (01) ◽

pp. 01-05 ◽

Cited By ~ 18

Author(s):

M. F. Besancon ◽

M. G. Conzemius ◽

K. G. Miles ◽

A. S. Kapatkin ◽

W. T. N. Culp ◽

...

Keyword(s):

Fracture Repair ◽

Fracture Reduction ◽

Vertical Force ◽

Condylar Fracture ◽

Limb Function ◽

Anatomic Reduction ◽

Post Traumatic ◽

Relationship Of ◽

The Relationship

SummaryThe frequency of post-traumatic osteoarthritis (PTO) in the dog after repair of a humeral condylar fracture (HCF) and the relationship of fracture reduction to outcome is unknown. The objectives of this study were to determine the frequency of PTO in dogs after HCF repair and to determine the relationship between fracture reduction, limb function and follow-up osteoarthrosis (OA) score. All dogs were evaluated by physical and radiographic examinations and dogs with unilateral fracture repair were also examined by force platform gait analysis. Initial and follow-up radiographs were scored for reduction and evidence of osteoarthrosis using previously published grading scales. This study evaluated 15 fractures in 13 dogs with a mean follow-up time of 43 months. Osteoarthrosis developed or progressed radiographically in all elbows. Peak vertical force (PVF) was significantly reduced (p <0.01) in the affected limb, however vertical impulse (VI) did not differ (p = 0.12) when compared to the opposite normal limb. Pain-free range of motion was reduced in flexion (p <0.01), but not in extension (p = 0.98) when compared to the normal limb. Fracture reduction score did not correlate with follow-up OA score (p = 0.07), PVF (p = 0.40), VI (p = 0.72), flexion (p =0.50), or extension (p = 0.62). Due to the high incidence of PTO, owners should be warned of the possibility of declining limb function over time despite near anatomic reduction.

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