J Korean Ophthalmol Soc.  2013 Sep;54(9):1315-1320.

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

• Choi AY
• Park SY
• Kook KH

Abstract

PURPOSE
To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid).
METHODS
To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction.
RESULTS
The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded.
CONCLUSIONS
Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.

Keyword

Bony strut; Inferomedial orbital wall fracture; Orbital implant; Overlapping method

MeSH Terms

Diplopia
Enophthalmos
Eye
Eye Movements
Floors and Floorcoverings
Follow-Up Studies
Humans
Orbit
Orbital Implants

Figure

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  Figure 1. (A) Schematic drawing of overlapping method for repairing of floor and medial wall fractures with loss of bony strut. (B), (C) Note the bended portion of floor implant to support the medial implant instead of the bony strut.

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  Figure 2. The maximal diagonal lengths of the orbit in the op-erated and non-operated eye were measured from the point of supero-lateral orbital edge to the bony strut.

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  Figure 3. Preoperative and post operative computed tomography images for repair of a combined infero-medial orbital wall fracture with loss of bony strut by an overlapping method. (A) Preoperative coronal view (B) Preoperative axial view (C) Postoperative coro-nal view. Note the similar size of the “box-shaped” orbit in both eyes (D) Postoperative axial view.

Reference

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