J Korean Ophthalmol Soc.  2014 Nov;55(11):1589-1594. 10.3341/jkos.2014.55.11.1589.

Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

• In JH
• Jang SY
• Choi YJ
• Choi HS
• Jang JW
• Kim SJ

• KMID: 2216604
• DOI: http://doi.org/10.3341/jkos.2014.55.11.1589

Abstract

PURPOSE
To evaluate surgical results after the reconstruction of isolated medial orbital wall fractures.
METHODS
We performed a retrospective chart review of patients with isolated medial orbital wall fractures who underwent reconstruction using the transcaruncular approach from March 2012 to October 2013. Computed tomography (CT) was performed before and after surgery. Postoperative follow-ups were conducted at 1 week, 1 month, and 3 months. Diplopia, ocular motility, postoperative complication, and exophthalmometry were recorded at each follow-up visit. Preoperative and postoperative enophthalmos was quantified using Hertel exophthalmometry and a quantitative method for the area of the circular sector under the chord (CA)/orbital area (OA) ratio at the CT scan. Patients were divided into either the incomplete or complete reduction groups based on the degree of reduction observed on postoperative CT.
RESULTS
We evaluated 55 patients (42 males, 13 females) with an average age of 36 years. Five of 55 patients with preoperative enophthalmos of more than 2 mm obtained good symmetry after surgery. Diplopia at primary gaze was resolved in 9 of 9 patients and 2 patients had residual diplopia on lateral gaze. The difference of exophthalmometry and CA-to OA ratio between before and after reconstruction was not significantly changed in either the incomplete or complete groups.
CONCLUSIONS
Enophthalmos and diplopia were well corrected in all subjects. If reduction was successfully performed in the anterior portion of medial orbital wall fracture, clinically significant enophthalmos might be preventable even if complete reduction was not obtained.

Keyword

Enophthalmos; Isolated medial orbital wall fracture; Surgical outcome

MeSH Terms

Diplopia
Enophthalmos
Follow-Up Studies
Humans
Male
Orbit*
Postoperative Complications
Retrospective Studies
Tomography, X-Ray Computed

Figure

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  Figure 1. Measurements of orbital parameters on axial computed tomography. CA = cord area; OA = oribital area; R = radius. A: Medial wall of the ethmoidal lamina papyracea; B, C: The point of intersecting the globe with the triangle; D: Lateral anterior zygomatic emergence; H1: Height of orbital triangle; H2: Height of triangle; α: The triangle.

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  Figure 2. Group 1: incomplete reduction (blow out fracture at med. Wall, Lt.). (A) Preoperative axial CT image. (B) Postoperative axial CT image.

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  Figure 3. Group 2: complete reduction (blow out fracture at med. Wall, Rt.). (A) Preoperative axial CT image. (B) Postoperative axial CT image: orbital soft-tissue herniation is decreased.

Reference

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