Secondary repair of late enophthalmos with calvarial bone grafts around intraorbital content: report of 2 cases

Kim, Sung Gil

Abstract

In the midfacial fracture, the orbital region presents many additional complication unique to the orbit. Among them are ectropion, entropion, lid ptosis, injury to the lacrimal apparatus, diplopia or the late development of enophthalmos. The residual problem confronting the surgen is usually enophthalmos or diplopia. Enophthalmos becomes cosmetically obvious at 3mm and if more severe it can interfere with vision from obstruction by the orbital rim. In this clinical situation, many patients prefer the simpler intraorbital volume expansion to the more complex orbital osteotomy. In general, except in mild cases of enophthalmos, the procedure of choice is osteotomy and repositioning for zygoma fracture and volume augmentation for blow-out fracture. Late treatment is performed by volume augmentation based on the CT findings behind the axis of the globe. Inferiorly placed grafts elevate the globe, posterior superior grafts move the globe anterior and medially positioned grafts push the globe laterally. In this two cases, the patients who has stable orbitozygomatic rim, the use of calvarial bone grafts more than 3 areas around intraorbital content, we corrected late enophthalmos combined with diplopia. As result , the first patient had 2mm advance in exophthalmometric check with improvement of the diplopia gradually. The second patient had 1.5mm advance with correction of vertical ocular dystopia and cosmetically good results respectively.