BackgroundRestoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method.MethodsA retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values.ResultsIn the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P<0.05). Upon ophthalmic examination, neither the differences among the groups in the perioperative Hertel scale nor the preoperative and postoperative Hertel scales were statistically significant (P>0.05).ConclusionsOur surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

No abstract

BackgroundEnophthalmos may not appear immediately after trauma due to periorbital swelling in a blowout fracture, and preoperative measurements of enophthalmos cannot be used as a reliable guideline. It is important to predict the eventual final extent of enophthalmos in order to determine whether to perform surgery, and there have been several attempts to predict the degree of late enophthalmos using preoperative orbital volume. The purpose of this study is to investigate the correlation between the orbital volume ratio (OVR) with final enophthalmos and the palpebral fissure, and to find the OVR that induced 2 mm of enophthalmos in unilateral unoperated blowout fractures.MethodsWe retrospectively reviewed the medical records of 38 patients and divided them into 3 groups, determined by the fracture location. The relationships between the OVR and both the degree of enophthalmos and the palpebral fissure ratio (PFR) were assessed and, in particular, the OVR that induced 2 mm of enophthalmos was sought.ResultsEnophthalmos increased in proportion to the OVR, and there was a highly significant correlation between the increase in the OVR and the degree of enophthalmos (P<0.05). On the other hand, there was no correlation between OVR and PFR (P>0.05). The OVR that induced 2-mm enophthalmos was 112.18%.ConclusionsThe final degree of enophthalmos can be estimated by the preoperative measurement of OVR. Preoperative measurements of OVR can be used as quantitative values to predict the final degree of enophthalmos in pure blowout fractures.

The purposes of this study were to observe bony orbital volume (OV) changes in pure blow-out fractures according to fracture location using a facial computed tomographic scan and to investigate whether the OV measurements can be used as a quantitative value for the evaluation of the surgical results of the acute blow-out fracture.Forty-five patients with unilateral pure blow-out fracture were divided into 3 groups: inferior (group I), inferior medial (group IM), and medial (group M) orbital wall fracture. The OV and the orbital volume ratio (OVR) were prospectively measured before and 6 months after surgery with the use of 3-dimensional computed tomographic scans, and the Hertel scale was measured with a Hertel exothalmometer.The preoperative OVR increased to the greatest extent in group IM, and the mean preoperative OVR was 121.46. The mean preoperative OVR in group I was significantly higher than that of group M (P = 0.005). The OV and OVR revealed a statistically significant decrease after the surgery (P = 0.000). The Hertel scale improved from -1.04 mm before the surgery to -0.78 mm after the surgery, but no significant difference was observed (P = 0.051).The OVR was useful as a quantitative value to evaluate pure blow-out fractures, compared with that of the Hertel scale. Fracture location-associated OVR studies are needed to make volume guidelines of blow-out fracture surgery.

We explored the vascular biology of adipose-derived stromal cells (ASCs) from diabetic patients and applied these cells to a murine ischemic flap model to assess the comparative angiogenic potentials between normal and diabetic human ASCs. ASCs were obtained from diabetic patients (n = 5) and controls (n = 5). Secretion and expression of angiogenic cytokines were measured under normoxic and hypoxic condition in vitro. Conditioned media harvested from ASC cultures were assessed for their ability to stimulate human umbilical vein endothelial cell proliferation and tubulization. The control and diabetic ASCs were injected into the murine ischemic flaps, and the surviving area was measured. Diabetic adipose-derived stromal cells showed a lower level of vascular endothelial growth factor expression and cell proliferation rates than the control cells (p < 0.05). However, vascular endothelial growth factor, hepatocyte growth factor secretion, tubulogenesis, and cell proliferation in diabetic conditioned media were increased in response to hypoxic stimuli (p < 0.05), and it was similar to those of control cells. In an animal study, diabetic and normal ASCs significantly increased flap survival (p < 0.05); however, the functional difference was not found between the two groups. Diabetic ASCs were impaired in their ability to produce vascular endothelial growth factors and to induce cellular proliferation under hypoxic conditions. However, diabetic ASCs showed similar flap salvaging effect compared with controls. These findings may be important in the context of future study of autologous cell-based therapy in diabetic patients.

BackgroundBioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws.MethodsA total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla.ResultsComplications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction.ConclusionsInadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.

Repairing a large inferomedial blowout fracture remains a challenge to orbital surgeon. The authors restored the fracture using combined transnasal and transorbital approaches using support of both paranasal sinuses. The authors compared surgical results of this novel method with those of the traditional procedure. Of 106 inferomedial blowout fracture patients who underwent surgical treatment between March 2007 and July 2013, 50 patients were selected in our study: 25 patients underwent the traditional procedure as controls, and the other 25 patients underwent orbital wall restoring surgery by our combined approach. Outcomes were evaluated in terms of the orbital volume ratio (OVR) and changes in Hertel scale. The OVR in the experimental group (7.19%) decreased more significantly than in the control group (2.71%) (P < 0.05). In conclusion, the orbit was restored more successfully following orbital wall restoring surgery with dual support than by using the traditional inferomedial blowout fracture procedure.

A combination of transconjunctival exploration and transnasal restoration with balloon support was more effective in restoring the orbital volume than the conventional method.