Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.

Bilateral globe luxation with multiple facial fractures: what next?

Luxation of the globe is a rare, vision-threatening event that can presently spontaneously or following trauma. A 35-year-old man presented with bilaterally luxated globe, postroad traffic accident. On imaging, bilateral LeFort fracture type 1, 2 and 3 with palatal split along with nasal bone and orbital floor fracture. Both condyles and left parasymphysis of mandible were fractured. There was no evidence of intracranial injury. There was pneumothorax on the right side for which intercostal drainage (ICD) tube was placed. On exploring, bilateral optic nerve avulsion was present. Both the globes were repositioned and a temporary tarsorrhaphy was placed for cosmetic rehabilitation. On follow-up visits after 6 months, both eyes were in their sockets with minimal exodeviation. It is important to reposition the globes, even with extensive periorbital fracture at the earliest. The longer the globe and orbital structures are prolapsed, the poorer are the structural and cosmetic prognosis owing to ocular ischaemia.

First description of a retrobulbar haemorrhage in a paediatric patient

An 8-year-old girl presented to the paediatric emergency department 3 days after left orbital exploration for an orbital floor fracture. She had been vomiting for the last 24 hours and her mother’s primary reason for presentation was that she was unable to keep down any analgesia . She reported pain in that eye and was unable to see. On examination, the eye was swollen and had yellow discharge. A CT scan was performed to rule out an infective collection and, unexpectedly, showed a retrobulbar haematoma. Ophthalmology was called and she was immediately taken to theatre for a lateral canthotomy for decompression. Fortunately, she regained her vision following this but, had the retrobulbar haematoma not been recognised urgently, she may have lost her vision permanently in that eye. Retrobulbar haematomas are quite rare in children this age and there is very little published literature on this topic.

New Extraocular Muscle Entrapment after Facial Fracture Repair

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.

Endoscopic transmaxillary repair of orbital floor fracture

Introduction: Orbital floor fracture repair is common practical clinic and challenging for most surgeons. Open reduction and internal fixation is conventional treatment for a long time. Recently, endocopy has been using as assisted method with many advantages. Materials and Methods: Cross-sectional study. The author reports first five cases in Vietnam which were reconstructed the orbital floor via maxillary sinus intra-oral approach with endoscopic-assisted at Viet Duc University Hospital from 2016 to 2019. Results: 5 cases (2 emergency surgeries and 3 selective surgeries) were treated with transmaxillar-sinus intra oral endoscopy for orbital floor reconstruction (2 titanium mesh, 1 absorable mesh, 2 porous polyethylenne mesh). All patients were evaluated with good results both in function and aesthetic aspect. No complication was recorded. One patient has facial numbness (innervated by inferior orbital nerve) but temporary and resolve after 3 months. Conclusion: The prelimenary results confirmed that transmaxillary-sinus intra-oral endoscopy for orbital floor reconstruction is reliable and safe method. Key word: Orbital fracture, facial trauma, enophthalmos, orbital floor reconstruction, endoscopic surgery. Tóm tắt Đặt vấn đề: Chấn thương sàn ổ mắt khá thường gặp trong thực hành lâm sàng. Điều trị các tổn thương này vẫn luôn là một thách thức với các bác sĩ phẫu thuật. Phương pháp kinh điển là mổ mở vào nếp má mi, dưới viền mi hoặc đường kết mạc. Việc sử dụng nội soi hỗ trợ hay toàn bộ giúp tăng cường khả năng quan sát chính xác của phẫu thuật viên, đặc biệt là với các thương tổn nằm sâu trong ổ mắt, từ đó giúp phục hồi tốt nhất về giải phẫu và thể tích ổ mắt. Phương pháp nghiên cứu: Nghiên cứu cắt ngang 05 người bệnh được chẩn đoán vỡ sàn ổ mắt được phẫu thuật tạo hình sàn ổ mắt với nội soi hỗ trợ từ năm 2016 đến năm 2019. Kết quả: Có 2 trường hợp được phẫu thuật cấp cứu vì kẹt cơ vận nhãn, 3 trường hợp phẫu thuật theo kế hoạch phục hồi sàn ổ mắt với vật liệu nhân tạo (2 Mesh Titanium, 1 Mesh tự tiêu, 2 Mesh Porous Polyethylene) mở xuyên xoang hàm qua đường miệng với nội soi hỗ trợ. Tất cả các trường hợp đều liền sẹo niêm mạc thì đầu, không có biến chứng nào được ghi nhận. Có một trường hợp bị tê bì vùng má (vị trí chi phối của thần kinh dưới ổ mắt) tạm thời, phục hồi hoàn toàn sau 3 tháng. Kết luận: Kết quả bước đầu cho thấy phẫu thuật tạo hình sàn ổ mắt qua đường miệng với nội soi hỗ trợ có những ưu điểm vượt trội cả về chức năng và thẩm mỹ. Từ khóa: Vỡ xương ổ mắt, chấn thương hàm mặt, lõm ổ mắt, tạo hình ổ mắt, phẫu thuật nội soi.