Objective To explore the secondary surgical reconstruction for orbital bone deformities accompanied with canthus dislocation after trauma. Methods From June 1998 to July 2007, 37 patients with secondary orbital bone fracture deformity accompanied with medial or lateral canthal l igament dislocation posttraumatically were treated, among whom there were 22 males and 15 females, aged 13-46 years old (21 on average). There were 29 cases of traffic accident, 6 of boxinginjury and 2 of beating injury by sticks. The latest reconstruction was performed on these 37 cases during 3 months to 8 years after injuries. There were 11 cases of orbital maxillary zygoma (OMZ) fracture, 15 of naso-orbito-ethmoid (NOE) fracture, 8 of OMZ and NOE fracture and 3 of frontal fracture. There were 31 patients who were reconstructed for the first time and 6 for the second time. Typical bicoronal and subcill iary incisions and intro-oral approach were employed to expose all the fractured sites. According to the fractured position and the degree of deformity and dislocation, the orbito-zygomatic fracture was repositioned after osteotomy and rigid fixation, or the heaved fragments were trimmed with a burr and the depressed fragments were filled with autogenous bone such as il ium, cranial outer table or Medpor in order to reconstruct orbital wall framework; the orbital walls were repaired to correct the enophthalmos with autogeneous bone or Medpor after the herniated orbital contents were released. The medial canthal l igament was anchored superior-posteriorly to the lacrimal fossa with transnasal wires fixation or fixed with titanium mini plates and nails. Results The 36 patients’ incisions obtained heal ing by first intention after the operation, and 1 case failed because of wound infection from maxillary sinusitis. There were 24 patients who were cured successfully with facial appearance and function improved significantly. During the follow-up for 3-6 months, no compl ication was found such as dislocation of the implant, rejection and infection. Two patients still showed sl ight enophthalmos while 3 patients with canthus dislocation regained improved appearances but not satisfactory. At 6 months after operation, the CT scan conducted in 3 patients with autogenous bone and Medpor grafting showed all fractures were fixed rigidly. Conclusion Surgical reduction combined with bone grafting is a satisfactory method for the correction of secondary orbital bone deformity, and the repair of canthus dislocation and correction of enophthalmos should be considered at the same time. An ideal result could be achieved only through all-round consideration and comprehensive treatment.
Objective To evaluate the clinical result of using osseointegratedimplants to retain removable orbital prostheses in repairing orbital defects. Methods Two patients with orbital defects caused by orbitaltumor were treated. Each of them got 4 implants. After average 6 months, we performed the secondary operation. After 7 weeks, we took impressions to make the implant-retained prostheses. The magnetic attachment was adopted. The prostheses were made of polysiloxane material(Factor II,Lakeside,Ariz). Results Both of the patients got the successful facial prostheses and were followed up 2 and 8 years respectively. All the implants were integrated well. There were no apparent inflammatory reactions in the soft tissue around percutaneous implants. The patients were satisfied with the facial appearance. Conclusion Implant-retained orbital prostheses are safe and effective in repairing orbital defects.
Objective To study the surgical reconstruction for correction of enophthalmos deformity caused by orbital blowout fractures. Methods From December 1996 to March 2004, 56 cases of enophthalmos deformity caused by orbital blow-out fracture were repaired. There were 37 cases diplopia, 35 cases with worsened visual acuity than pretrauma. Typical sub-ciliary incision was employed to expose the fractured area.The dissection was done beneath the medial and inferior obital periosteum. The fracture areas were exposed and the tissues protrusing to sinus maxillaries were released through the space between fractural bones. After the medial and inferior orbital walls and orbital floors were exposed，the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with Medpor which were fixed to the area beneaththe periosteum with 2 plates at least. Results All 56 cases ofenophthalmos deformity caused by orbital blow-out fracture repaired with this technique recovered well and their facial appearance improved greatly. With a follow-up ranged from 2 months to 5 years, the degree of enophthalmos stabilized at within 2 mm, no relapse and other complications occurred. Of 34 patients with diplopia, 27 were improved. Of the 35 cases with worsened visual acuity, 9 were improved with different degree. No diplopia or visual acuity worsening occurred. Conclusion It is safe and effectiveto correct the orbital blow-out fractures. The earlier it is repaired, thebetter the effect will be. Medpor with its advantages like better histocompatibility, easier sculpturing, moderate hardness, lower absorptivity, fewer complications and permanence effect is the preferable implantation material for correcting enophthalmos deformity.
Objective To observe the clinical manifestations and the effect factors of thyroid-associated ophthalmopath (TAO) with optic neuropathy. Methods The clinical data of 62 cases (120 eyes) of TAO with optic neuropathy diagnosed in 1994-2001 were retrospectively analyzed. Results The incidence of TAO with optic neuropathy was 18.3% in all the simultaneous TAO inpatients, and was more frequently found in the male than in the female ones. The incidence of TAO with optic neuropathy was correlated with orbitono-increase, ocular myopathy, hypertension, hyperlipemia, diabetes, and cardiopathy (P＜0.0000), but not with exophthalmos, intraocular pressure, and the disease course of TAO (Pgt;0.05). In 62 patients with the methylprednisolone pulse therapy, the visual acuity improved in 33 (29.0%), improved while the treatment but decreased after stop treating in 29 (24.2%), and no changes in 58 (46.8%). In 63 eyes undergone orbital decompression with methylprednisolone pulse therapy, 59 (93.7%) had better visual acuity. Conclusion The incidence of TAO with optic neuropathy was correlated with orbitono-increase, ocular myopathy, hypertension, hyperlipemia, diabetes, and cardiopathy. Met hylprednisolone pulse therapy and orbital decompression are the effective measures for TAO with optic neuropathy. (Chin J Ocul Fundus Dis，2004，20：142-144)
Objective To observe the functional state of the optic nerve and discover the injury of visual pathway function in time under general ane sthesia. The flash visual evoked potential (F-VEP) was used to monitor visual function during orbital surgery. Methods A total of 252 out of 282 patients undergoing orbital surgery under general anesthesia were successfully monitored by F-VEP during the surgery. All patients were monitored by this method under the following conditions:consious state before operation, under general anaesthesia, during and after dissection of orbital tumor and at the end of operation. Results ①There was no significant difference of wave amplitude and latency under general anesthesia and consciousness condition. ②The amplitude and latency of F-VEP were normal in the orbital surgery withou toptic nerve injury. ③Pulling and oppression of optic nerve could cause temporary wave loss, but the wave recovered after removal of the pull and oppression. ④ The wave loss of F-VEP would occur immedicately when optic nerve was severe injured and its blood supply was deficient. Since the application of the visual function monitoring, 24 cases were treated in time during disturbance of visual function and no patient has unexpected visual loss during orbital surgery. Conclusion The intraoperative monitoring of F-VEP during orbital surgery can decrease the proportion of permanent visual loss caused by orbit al surgery, and help the surgical procedures go to function-anatomy stage from experience-anatomy stage. (Chin J Ocul Fundus Dis, 2001,17:260-263)
Objective To provide references for clinical management of patients with orbital blow-out fractures. Methods Evidence was retrieved from The Cochrane Library online (Issue 1, 2009), ACP online, NGC (1998 to March 2009), PubMed (January 1950 to February 2009), and CBM (1994 to February 2009). The collected evidence was then graded. Results After preliminary research, we identified 12 relevant articles: either retrospective studies or comments from specialists. They studied orbital soft tissue entrapment, diplopia, enophthalmos, or severe oculocardiac reflex in the surgical indications of orbital blow-out fractures. Most of the literature suggested less than five days after the injury incursion for children and less than two weeks for adults was the optimal time to undergo operation. However, advanced surgery was still a good option for the patients that could not undergo early surgery. With regard to the use of poly-pdioxanon- foil and titanium-dynamic mesh, two randomized controlled trials suggested that the former was superior to the latter. Conclusion The application of this surgery should be cautious because of low levels of evidence. Individual therapies should be used after close consideration of clinical characteristics.
ObjectiveTo explore the plastic surgical treatment and the way to reduce hemorrhage for scalp and facial plexiform neurofibromas. MethodsBetween July 2004 and July 2013, 20 patients with scalp and facial plexiform neurofibromas (17 cases of neurofibromatosis type Ⅰ and 3 cases of plexiform neurofibroma) were treated, and the clinical data were retrospectively analyzed. There were 9 males and 11 females with an average age of 37 years (range, 18-56 years). The disease duration ranged from 8 to 56 years (mean, 19 years). The scalp was involved in 6 cases, the face in 7 cases, and both the scalp and face in 7 cases. The extent of involvement ranged from 4 cm×3 cm to 15 cm×13 cm. Obvious pigmentation was seen in 2 cases. Endovascular embolization was performed before surgical intervention in 4 cases. Preliminary sutures around the lesion were carried out in 18 cases having an involved range over 5 cm×5 cm. One-stage excision was performed in 17 cases, and two-stage excision in 3 cases. Wound repair and facial orthopedic treatment were performed after tumor excision. ResultsThe intraoperative blood loss was 100-500 mL (mean, 300 mL) for patients undergoing single operation. For 3 patients undergoing two-stage excision, the blood loss of the first operation was 500, 600, and 800 mL respectively, and the blood loss of the second operation was all 50 mL. Autologous blood transfusion of 200, 400, and 400 mL was performed in 3 cases respectively. The preliminary sutures were removed at 3-7 days (mean, 5 days) after operation. All the incisions healed primarily without secondary hemorrhage and hematoma, and the flap and skin graft survived totally. Fifteen patients were followed up 1 year to 7 years (mean, 2.5 years). All patients showed significant improvement in appearance. No significant progression, expanding, and sagging were observed. ConclusionEndovascular embolization and preliminary sutures around the lesion can be used to reduce hemorrhage in resection of plexiform neurofibroma in the scalp and face. Personalized surgical plan of benign neurofibromatosis should be made to reduce the tumor mass, to improve function and appearance.