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1.
J Craniofac Surg ; 31(1): 54-57, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31425407

RESUMEN

Craniomaxillofacial and plastic surgeons are often confronted with patients who present with enophthalmos caused mainly by trauma. In many patients, one-stage reconstruction repairs only the bony orbit, leaving intact the disfiguring enophthalmos. Thus, some filler is needed to restore the normal volume of the orbit. The authors describe a technique to correct such deformation safely and effectively. Data were collected from 30 enophthalmic patients (average age 36.67 ±â€Š11.66 years) who underwent retro-ocular injections of fat globules between August 2014 and July 2018. CT helped identify a safe injection site, and specific CT measurements quantified the volume of fat globules required. There was a significant difference between the preoperative and postoperative values for lateral orbital protrusion (P < .01), superior orbital protrusion (P < .01), and orbital volume (P < .01). Most patients were satisfied with the outcome. There were no significant complications. Injecting fat globules into the retro-orbital area is an effective technique for correcting enophthalmos deformity.


Asunto(s)
Enoftalmia/cirugía , Adolescente , Adulto , Grasas/administración & dosificación , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Órbita/cirugía , Adulto Joven
3.
Br J Oral Maxillofac Surg ; 57(9): 904-912, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31431316

RESUMEN

Enophthalmos has many causes, and serious post-traumatic cases indicate the need for operation. Such diagnoses should be made objectively, and a robust method for quantifying the degree to which the globe has been displaced is key. Current methods of measurement, however, have long been considered unreliable and inconsistent, in particular with regard to interobserver variability. The aim of this paper therefore was to review all these methods systematically, to analyse their reliability, and to compare them with others. The paper also includes a proposed protocol for the accurate and reliable measurement of protrusion of an eye, which aims to standardise the assessment of patients and to create a uniform approach that will enable the selection of those who are most likely to benefit from surgical treatment. Analysis of the data showed that computed tomographic (CT) exophthalmometry is the most reliable, followed by the Mourits' exophthalmometer, which performed better than the other clinical methods. In the acute phase of orbital blowout fractures, the measurement of herniated tissue through a fracture defect may give a good prediction of the degree of enophthalmos that is likely to occur without surgical correction. Measurement of the herniated volume and CT exophthalmometry should be the foundation for diagnosis and the planning of treatment. Three-dimensional imaging or Mourits' exophthalmometers (which are reliable non-radiological methods) could be used in a follow-up protocol.


Asunto(s)
Enoftalmia , Exoftalmia , Fracturas Orbitales , Enoftalmia/diagnóstico , Enoftalmia/cirugía , Exoftalmia/diagnóstico , Exoftalmia/cirugía , Ojo , Huesos Faciales/lesiones , Huesos Faciales/cirugía , Humanos , Órbita , Fracturas Orbitales/diagnóstico , Fracturas Orbitales/cirugía , Reproducibilidad de los Resultados
4.
Acta Otolaryngol ; 139(1): 64-69, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30712438

RESUMEN

BACKGROUND: Silent sinus syndrome (SSS) is defined as spontaneous, painless enophthalmos, hypoglobus with orbital floor resorption and maxillary sinus collapse on the ipsilateral side. Different methods of orbital floor reconstruction have been proposed. AIMS/OBJECTIVES: The purpose was to analyse the results of combined endoscopic sinus surgery (ESS) and reconstruction using orbital floor implant of 15 patients with SSS and to present recent histological findings. MATERIALS AND METHODS: Retrospective case review of 15 patients with SSS treated in clinic between 2007 and 2017. RESULTS: Eleven women and four men presented with unilateral, spontaneous enophthalmos. Averaged duration of enophthalmos was 10.7 months. On affected side, mean enophthalmos was 2.6 mm and hypoglobus 2.7 mm. Computed tomography imaging (CT) imaging showed maxillary sinus opacification on the affected side in every case, and the orbital floor was displaced downwards in all cases. In total, 13 patients underwent simultaneous ESS and rebuilding of orbital floor with a titanium implant. Statistical analysis confirmed significant differences for pre- and postoperative measure of enophthalmos and hypoglobus. CONCLUSION AND SIGNIFICANCE: Implementation of titanium implants is the reliable method of reconstruction that allows good aesthetic result, shorter time of procedure with an excellent long-term outcome and satisfactory patient's tolerance.


Asunto(s)
Enoftalmia/etiología , Órbita/cirugía , Enfermedades de los Senos Paranasales/complicaciones , Adulto , Enoftalmia/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales , Enfermedades de los Senos Paranasales/cirugía , Implantación de Prótesis , Estudios Retrospectivos
5.
J Craniofac Surg ; 30(4): 1208-1210, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30676443

RESUMEN

The aim of this study was to assess compositional changes in a forged-unsintered hydroxyapatite and poly-L-lactide (uHA/PLLA) mesh at 651 days after insertion into human body.A 35-year-old female patient had left tripod fracture, orbital medial wall and floor fracture, and superficial lateral palpebral ligament rupture. On the 9th posttrauma day, the tripod fracture was reduced and fixed with plates, and the orbital wall and floor were reconstructed with a resorbable mesh. The floor and medial wall were reconstructed with a trimmed mesh made of uHA/PLLA (Osterotrans-MX; Takiron Co, Umeda, Japan). On postoperative day 620, she complained of enophthalmos of left eye (right eye, 18 mm; left eye, 16 mm). Secondary reconstruction of the orbital floor was performed with an iliac bone graft 651 days after insertion. During the secondary operation, the uHA/PLLA mesh that had been previously inserted was removed. The mesh was removed and analyzed using gel permeation chromatography (GPC) and Fourier transform infrared spectroscopy (FTIR).The GPC revealed that the weight average molecular weight (Mw) decreased from 542,000 to 83,300 Da and the number average molecular weight (Mn) decreased from 124,000 to 20,200 Da in the specimen from the operation. In the postinsertion FTIR spectrum, weak 1648.6 and 1656.1/cm peaks newly appeared. The strong 1038/cm peak of the initial specimen changed slightly into a less strong 1041.8/cm peak.In conclusion, the reduced Mw and Mn in the postinsertion specimen suggest that uHA/PLLA has one of the favorable degradation properties. The newly appeared bands are thought to be carbon-carbon double bonds of alkenes.


Asunto(s)
Implantes Absorbibles , Enoftalmia , Ensayo de Materiales/métodos , Fracturas Orbitales/cirugía , Mallas Quirúrgicas , Adulto , Remoción de Dispositivos , Durapatita/química , Durapatita/farmacología , Enoftalmia/diagnóstico , Enoftalmia/etiología , Enoftalmia/cirugía , Femenino , Humanos , Japón , Poliésteres/química , Poliésteres/farmacología
6.
Aesthetic Plast Surg ; 43(1): 123-132, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30242462

RESUMEN

BACKGROUND: Orbital volume loss, early or late, is common after placement of an orbital implant or dermis fat graft, and there is currently no satisfactory long-lasting solution. Hyaluronic fillers are relatively easy to administer but are prone to migration and are temporary. Cannula-based orbital fat grafting has not gained the status of standard of care because of perceived low likelihood of success in the near term. This paper describes a technique for fat volume augmentation, its rationale, long-term follow-up, and a description of a complication unique to fat grafting in the orbit. METHODS: Ten consecutive subjects with acquired anophthalmic enophthalmos were enrolled in two IRB (institutional review board)-approved protocols (10.27 and 12.01) undergoing a single session of autologous fat grafting to the orbit using a closed blunt cannula technique. Preoperative photography and non-contrast MRIs (magnetic resonance imaging) were obtained prior, immediately after, and at 1 year after injection. Yearly postoperative photography was performed on subjects with successful results. RESULTS: Three of five subjects in IRB 10.27 clearly showed a clinically apparent increase in orbital volume at 1 year. One subject who failed to show improvement also sustained inadvertent injection into three extraocular muscles; she subsequently volunteered to enter IRB 12.01. Three of five subjects in IRB 12.01 did benefit, showing volume increase at 1 year, including the subject who had experienced intramuscular injection in 10.27. One subject in IRB 12.01 was lost to follow-up. Of the total of ten subjects enrolled, three showed no improvement and one was lost to follow-up; six subjects showed volume improvement at 1 year with two retaining the correction at 5 years and four showing variable diminution over 2-5 years. With the exception of the subject who sustained injection into extraocular muscles, none experienced complications. CONCLUSION: A modified technique is recommended for orbital fat injection distinct from methods used elsewhere in the body. Theoretical limits of volumetric enhancement temper expectations in orbital fat grafting and should inform surgical planning. Cannula-based orbital fat grafting can be done safely and result in a gain of orbital fat volume at 1 year and in some cases up to 5 years. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Asunto(s)
Tejido Adiposo/trasplante , Enoftalmia/cirugía , Órbita/fisiopatología , Anciano , Autoinjertos , Estudios de Cohortes , Enoftalmia/diagnóstico por imagen , Estética , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intralesiones , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Cirugía Plástica/métodos , Resultado del Tratamiento
8.
Eye (Lond) ; 32(12): 1864-1870, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30154573

RESUMEN

OBJECTIVES: To describe and evaluate a novel surgical approach to orbital wall reconstruction that uses three-dimensionally (3D) printed templates to mold a customized orbital implant. METHODS: A review was conducted of 11 consecutive patients who underwent orbital wall reconstruction using 3D-printed customized orbital implant templates. In these procedures, the orbital implant was 3D pressed during surgery and inserted into the fracture site. The outcomes of this approach were analyzed quantitatively by measuring the orbital tissue volumes within the bony orbit using computed tomography. RESULTS: All 11 orbital wall reconstructions (6 orbital floor and 5 medial wall fractures) were successful with no post operative ophthalmic complications. Statistically significant differences were found between the preoperative and post operative orbital tissue volumes for the affected orbit (24.00 ± 1.74 vs 22.31 ± 1.90 cm3; P = 0.003). There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction (22.01 ± 1.60 cm3 vs 22.31 ± 1.90 cm3; P = 0.182). CONCLUSION: 3D-printed customized orbital implant templates can be used to press and trim conventional implantable materials with patient-specific contours and sizes for optimal orbital wall reconstruction. It is difficult to design an orbital implant that exactly matches the shape and surface of a blowout fracture site due to the unique 3D structure of the orbit. The traditional surgical method is to visually inspect the fracture site and use eye measurements to cut a two-dimensional orbital implant that corresponds to the anatomical structure of the fracture site. However, implants that do not fit the anatomical structure of a fracture site well can cause complications such as enophthalmos, diplopia and displacement of the implant.


Asunto(s)
Enoftalmia/cirugía , Órbita/cirugía , Fracturas Orbitales/cirugía , Implantes Orbitales , Impresión Tridimensional , Diseño de Prótesis/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Adulto Joven
9.
Plast Reconstr Surg ; 142(2): 169e-178e, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30045183

RESUMEN

BACKGROUND: Posttraumatic enophthalmos has debilitating functional consequences, resulting in restriction of ocular motility and diplopia. Surgical correction aims to restore the globe position and ultimately improve function. This study evaluates the functional outcome of posttraumatic enophthalmos repair. METHODS: Patients included in this study had posttraumatic enophthalmos and diplopia requiring enophthalmos repair. Diplopia was graded from 0 (no diplopia) to 4 (constant diplopia) based on the Functional Diplopia Grading Scale. Limitations of eye movements were recorded in the vertical, horizontal, and torsional directions. Data were gathered prospectively at preoperative assessment, postenophthalmos repair, and final follow-up. RESULTS: Between 2002 and 2014, 41 patients fulfilled inclusion criteria. Substantial functional improvement, defined as a decrease of greater than or equal to 1 grade of diplopia, was achieved in 65.9 percent of patients (27 of 41) after all surgical interventions. Patients with residual diplopia (34 of 41) after enophthalmos surgery were managed with secondary strabismus surgery (10 of 34) and/or prism glasses (four of 34). After all interventions, vertical restrictions improved from -1.95 ± 1.13 to -1.06 ± 0.98. Horizontal restrictions improved from -0.88 ± 0.62 to 0.59 ± 0.6. Adequate clinical correction of enophthalmos to within 2 mm of the contralateral globe was achieved in 37 of 41. CONCLUSIONS: This is the largest case series evaluating functional outcomes of patients undergoing posttraumatic delayed enophthalmos repair. A multidisciplinary care approach resulted in improved globe position and eye movement, and improvement of diplopia. Further studies with larger sample sizes are needed to better understand and treat this important and challenging problem. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Enoftalmia/cirugía , Fracturas Orbitales/complicaciones , Procedimientos Ortopédicos/métodos , Adolescente , Adulto , Anciano , Enoftalmia/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
10.
J Craniofac Surg ; 29(7): 1693-1696, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29863555

RESUMEN

INTRODUCTION: The use of resorbable materials is becoming more popular for pediatric orbital floor reconstruction. The purpose of this systematic review is to evaluate the effectiveness and safety of the various materials used in pediatric orbital floor reconstruction. METHODS: A systematic literature search was performed to identify all relevant articles reporting complications following pediatric orbital floor reconstruction. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and PubMed starting from database establishment to July 2017. Primary endpoints were enophthalmos, diplopia, and infection. Resorbable material was compared to autologous grafts and nonresorbable material. RESULTS: A total of 14 studies containing 248 patients were included in this review. Fifty-four (21.8%) patients had reconstruction performed with autologous grafts, 72 (29.0%) patients with resorbable material, and 122 (49.2%) patients with nonresorbable material. Resorbable materials had the lowest rate of postoperative enophthalmos (3/52; 5.8%) and the highest rate of postoperative diplopia (19/72; 26.4%). In contrast, nonresorbable materials had the lowest rate of postoperative diplopia (5/122; 4.1%), the highest rate of postoperative enophthalmos (14/102; 13.7%). Autologous reconstruction was associated with an 11.1% (4/36) rate of postoperative enophthalmos and a 22.2% (12/54) rate of postoperative diplopia. Nine cases (8.8%) of postoperative infection were documented with nonresorbable materials. No cases of infection were reported with autologous grafts or resorbable materials. CONCLUSION: Newer resorbable implants are safe and have a similar complication profile as traditional autologous grafts in pediatric orbital floor reconstruction.


Asunto(s)
Enoftalmia/cirugía , Fracturas Orbitales/cirugía , Implantes Orbitales , Procedimientos Quirúrgicos Reconstructivos/métodos , Niño , Enoftalmia/diagnóstico , Humanos , Fracturas Orbitales/diagnóstico , Diseño de Prótesis , Tomografía Computarizada por Rayos X
11.
Artículo en Chino | MEDLINE | ID: mdl-29798148

RESUMEN

Objective:To study the efficacy of endoscopic sinus approach in the repair of medial orbital fracture with perpendicular plate of ethmoid.Method:Retrospective chart was reviewed in 10 cases receiving endoscopic approach to reconstruct the medial orbital fracture with perpendicular plate of ethmoid.We observed the improvement of the symptom such as diplopia, eye movement,and enophthalmos of the preoperative and postoperative.Result:After postoperative follow-up of 4 months to 23 months, all the patients had no graft loss or displacement, infection and other complications, and except for 1 patient with mild diplopia, other patients recovered completely, including eye movement disorder, diplopia,and enophthalmos.Conclusion:Endoscopic approach is a safe and effective treatment in the repair of medial orbital fracture with perpendicular plate of ethmoid.


Asunto(s)
Endoscopía , Fracturas Orbitales/cirugía , Enoftalmia/etiología , Enoftalmia/cirugía , Humanos , Fracturas Orbitales/complicaciones , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
12.
J Oral Maxillofac Surg ; 76(10): 2161-2167, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29738747

RESUMEN

PURPOSE: The purpose of this study was to evaluate the orbital patient-specific implant (PSI) directly printed in porous titanium for the reconstruction of complex orbital bone defects in a series of 12 patients. PATIENTS AND METHODS: The authors designed and implemented a case series. The sample consisted of patients with unilateral complex orbital bone loss. All patients received a porous titanium PSI designed from the healthy contralateral side (mirroring). The criteria analyzed were the functional results: correction of enophthalmos, correction of ocular motility, operative time, complications, and operative revisions. The study was performed from 2015 through 2017. RESULTS: The sample was composed of 12 patients (mean age, 47 yr; age range, 13 to 70 yr). Patients were followed for a mean of 36 weeks postoperatively (range, 4 to 100 weeks). Twelve of the 12 patients presented preoperative enophthalmia, and 8 of the 12 patients presented preoperative diplopia. The mean operating time was 71 minutes (range, 60 to 200 minutes). For 8 patients, the follow-up was simple. In contrast, 2 patients required surgical revision with repositioning of the implant because of intraoperative implant malpositioning with esthetic or functional disturbance and malpositioning was confirmed on the postoperative computed tomogram, 1 patient required explantation of his implant 7 months after the surgery because of spheno-orbital meningioma recurrence (the implant was well positioned), and 1 patient operated on by a subciliary approach presented a postoperative ectropion. In this series of porous titanium orbital PSIs without positioning guides, 17% had malpositioning (2 patients who required a new intervention for repositioning). CONCLUSION: The results of this study suggest that porous titanium PSI could be a surgical option for patients with complex orbital bone defects. In this series 17% of the sample needed a second operation. There are several ways to improve these results, such as intraoperative navigation or integrated positioning guides.


Asunto(s)
Enoftalmia/diagnóstico por imagen , Enoftalmia/cirugía , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Implantes Orbitales , Impresión Tridimensional , Procedimientos Quirúrgicos Reconstructivos/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Modelación Específica para el Paciente , Porosidad , Diseño de Prótesis , Estudios Retrospectivos , Titanio , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Microtomografía por Rayos X
13.
J Oral Maxillofac Surg ; 76(9): 1937-1945, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29654775

RESUMEN

PURPOSE: To determine the relation between overcorrection of orbital volume and ocular projection in patients with orbital trauma. MATERIALS AND METHODS: A prospective cohort study was performed of patients with enophthalmos as a side effect of orbital trauma. The sample included patients older than 18 years who required reconstruction using customized implants to treat enophthalmos with or without diplopia. The exclusion criteria were patients who had multiple or extended fractures and patients with amaurosis or a prosthetic eye. Orbital volumes were calculated and the position of the eyeball in the healthy and traumatized sockets was determined before and after installing the implant and the ratio between these variables was calculated. Two variables were identified: 1) orbital volume and 2) enophthalmos. Analysis of the estimator variables was performed, defining 3 groups: 1) healthy eye socket, 2) traumatized eye socket without implant, and 3) traumatized eye socket with implant. The Shapiro-Wilk test, paired t test, and linear regression analysis were performed. A P value less than .05 (95% confidence interval) indicated significant differences. RESULTS: Of 294 patients who underwent orbital zygomatic complex reconstruction surgery, 13 required customized implants and only 5 met the inclusion criteria. The average volumetric variation in the groups of traumatized eye sockets with and without implants was statistically significant (P < .05), overcorrecting by an average of 4.2 cm3. The average enophthalmos variation in the groups of traumatized eye sockets with and without implants was statistically significant (P < .05), projecting the eyeball by an average 1.80 mm. The ratio between the average orbital volume and projection of the eyeball was determined to be 1:0.721 (correlation, 45.6%). CONCLUSION: This study concluded that the eyeball is projected 0.7 mm for every 1 cm3 of volume added in customized orbital implants. However, additional clinical studies with larger samples should be conducted.


Asunto(s)
Enoftalmia/cirugía , Lesiones Oculares/cirugía , Implantes Orbitales , Implantación de Prótesis/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Enoftalmia/diagnóstico por imagen , Enoftalmia/etiología , Lesiones Oculares/complicaciones , Lesiones Oculares/diagnóstico por imagen , Femenino , Humanos , Masculino , Estudios Prospectivos , Diseño de Prótesis , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
14.
J Craniofac Surg ; 29(4): 1006-1011, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29561480

RESUMEN

Posttraumatic enophthalmos due to isolated or complex orbital fractures can contribute to diplopia. Current evidence recommends early repair. However, little is known about the outcome of enophthalmos correction when repair occurs beyond 30 days after trauma. In this systematic review, the authors aim to evaluate the current evidence on functional outcomes after delayed repair of posttraumatic enophthalmos.Two independent assessors undertook a systematic review of the literature using multiple databases. The authors' inclusion criteria identified studies involving patients at least 14 years of age who had surgical correction of persistent enophthalmos 30 days after initial trauma. Each eligible paper was included after critical appraisal using validated guidelines. Data on preoperative and postoperative enophthalmos and diplopia in each study was extracted. The pattern of fracture was also noted.The authors' search for the medical databases yielded 1053 articles, of which 6 eligible papers were included. Meta-analysis was performed. In patients with complex injuries involving orbital and mid-facial fractures, diplopia resolution was calculated to be 53%, and enophthalmos was corrected in 83% of the patients. In patients with isolated orbital fractures, 53% had resolution of their diplopia, and enophthalmos was corrected in 88% of the patients.Enophthalmos can be corrected to within 2 mm of the contralateral eye in both the isolated and complex orbital fractures in patients who present 30 days or greater after injury. Based on the studies reviewed, there is less predictability in diplopia resolution.


Asunto(s)
Diplopía , Enoftalmia , Traumatismos Faciales/cirugía , Diplopía/epidemiología , Diplopía/etiología , Enoftalmia/complicaciones , Enoftalmia/epidemiología , Enoftalmia/cirugía , Traumatismos Faciales/complicaciones , Traumatismos Faciales/epidemiología , Humanos , Resultado del Tratamiento
15.
Ophthalmic Plast Reconstr Surg ; 34(4): 378-380, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29329172

RESUMEN

PURPOSE: To identify demographic features and clinical outcomes associated with post-traumatic silent sinus syndrome. METHODS: A retrospective review was carried out at 3 academic medical centers to identify all cases of post-traumatic silent sinus syndrome. Clinical features and management strategies were recorded. Postoperative outcomes were assessed, and statistical analyses were performed via a dedicated computerized software package. RESULTS: Twenty cases were identified (14 men and 6 women, mean age = 44.2 years). Seven patients underwent sinus surgery as the sole means of treatment, and the mean pre- and postoperative enophthalmos measurements were 2.86 and 1.93 mm. Alternatively, 13 patients underwent combined orbital reconstruction and sinus surgery, respectively; the mean pre- and postoperative enophthalmos measurements were 3.42 and 0.39 mm, respectively. The change in enophthalmos was statistically significantly greater in patients who underwent sinus surgery and orbital reconstruction (p = 0.00028). Among patients who underwent sinus surgery alone, one patients (14.2%) experienced complete resolution of enophthalmos, as compared with 10 patients (76.9%) who underwent combined procedures. CONCLUSIONS: This study represents the largest published cohort of patients with post-traumatic silent sinus syndrome. Combined orbital reconstruction and sinus surgery results in greater reductions of enophthalmos and a markedly improved chance of postoperative symmetry of globe position.


Asunto(s)
Fracturas Orbitales/complicaciones , Enfermedades de los Senos Paranasales/cirugía , Senos Paranasales/cirugía , Adulto , Endoscopía , Enoftalmia/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/etiología , Estudios Retrospectivos , Adulto Joven
17.
Ophthalmic Plast Reconstr Surg ; 34(4): 381-386, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29369151

RESUMEN

PURPOSE: The treatment of enophthalmos and sunken upper eyelid is challenging. Although autologous fat graft has been widely used in breast augmentation, buttock contouring, and facial rejuvenation, its application in enophthalmos and sunken upper eyelid is not yet widely utilized. The clinical safety and value of autologous fat graft in sighted patients with enophthalmos and sunken upper eyelid are unclear. This study retrospectively analyzed the cosmetic results and safety of autologous fat graft in the correction of sighted traumatic enophthalmos and sunken upper eyelid. METHODS: Autologous fat graft was performed in 9 patients with posttraumatic enophthalmos and sunken upper eyelid. The visual acuity, orbital swelling, eye movement, enophthalmos, and sunken upper eyelid were observed. RESULTS: Eight to 24 months after autologous fat graft, enophthalmos and sunken upper eyelid in 9 patients improved significantly. Although orbital swelling occurred in the early postoperative period, no vision loss, eye movement limitation, or fat embolism had occurred. CONCLUSION: Autologous fat graft is an effective, predictable, scarless, and minimally invasive surgery for the correction of the sighted posttraumatic enophthalmos and sunken upper eyelid. The possible risk of fat embolization and blindness from the compression of the optic nerve should not be neglected. Further studies and more cases must be performed.


Asunto(s)
Tejido Adiposo/trasplante , Blefaroplastia/métodos , Enoftalmia/cirugía , Lesiones Oculares/complicaciones , Enfermedades de los Párpados/cirugía , Adulto , Enoftalmia/etiología , Enoftalmia/fisiopatología , Movimientos Oculares/fisiología , Enfermedades de los Párpados/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Autólogo , Agudeza Visual/fisiología , Adulto Joven
19.
Ann Chir Plast Esthet ; 63(1): 91-96, 2018 Feb.
Artículo en Francés | MEDLINE | ID: mdl-28457727

RESUMEN

INTRODUCTION: Reconstruction of craniofacial defects due to traumatic injuries is a challenge for a reconstructive surgeon, given the functional impact, the aesthetic impact and the geometric complexity of the craniofacial skeleton. The use of cutting and repositioning guides enables a new approach from the craniofacial reconstruction with bone grafts on measure. We are presented to illustrate this technique the case of a patient. OBSERVATION: The patient was 50 years old, he presented a traumatic facial sequelar: a left frontal craniofacial deformation, an enlarged left orbit with enophthalmos and valgus left zygoma. The patient had a permanent diplopia, an important aesthetic and social gene impeding daily life. Surgical planning was performed for optimal care. We performed a cranioplasty frontotemporal by bone parietal duplication, osteotomy of zygoma and intra-orbital bone graft customized using cutting guides. The bone pieces were positioned with the repositioning books. DISCUSSION: This presentation illustrates a novel application of cutting guides. This technique has the advantage of using customized autologous bone. This is the gold standard, it requires surgical experience.


Asunto(s)
Trasplante Óseo , Hueso Frontal/cirugía , Imagenología Tridimensional , Órbita/cirugía , Cirugía Asistida por Computador , Cigoma/cirugía , Trasplante Óseo/métodos , Diplopía/etiología , Diplopía/cirugía , Enoftalmia/cirugía , Estética , Hueso Frontal/lesiones , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Órbita/lesiones , Fracturas Orbitales/cirugía , Osteotomía/métodos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Cigoma/lesiones
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