Pseudo-Brown Syndrome: A Potential Ophthalmologic Sequela After a Transcaruncular–Transconjunctival Approach for Orbital Fracture Repair

Haller, Raoul Michel De; Imholz, Benoît; Scolozzi, Paolo

doi:10.1016/j.joms.2012.03.015

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…Iatrogenic IOM palsy has been documented by Tiedemann et al 15 In cases with diplopia, several studies in which IOM was permitted to attach spontaneously reported double vision; most cases were transient, as in this study. 4,16,17 In our study, IOM underaction was not always correlated with diplopia, with 4 out of 13 patients showing diplopia at the last follow-up. The inflammation and accompanying injuries after severe trauma made it difficult to evaluate the function of IOM preoperatively.…”

Section: Discussioncontrasting

confidence: 64%

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Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Park

Choi

2022

OPTH

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Background: Detachment of the inferior oblique muscle may be necessary under certain circumstances to repair a large inferomedial orbital fracture involving the orbital strut. This study aimed to evaluate the outcomes of patients who underwent surgeries with and without inferior oblique muscle reattachment after its detachment to repair the orbital wall fractures. Methods: Forty patients who underwent repair of combined floor and medial orbital wall fracture involving the orbital strut at a single tertiary institution between January 2014 and December 2020 were reviewed. Groups 1 and 2 comprised 20 patients each, who underwent surgery with inferior oblique muscle detachment without and with reattachment, respectively, and were followed up for at least 6 months postoperatively. Enophthalmos, Goldmann diplopia test, alignment test, ocular motility test, and orbital inferomedial angle ratio were the outcome measures. Results: Statistically significant improvement was observed in ocular motility, diplopia, and enophthalmos postoperatively at the 1and 6-month follow-up (p < 0.01). The mean postoperative inferomedial angle ratio (102.28 ± 10.62%) was improved significantly compared with the preoperative inferomedial angle ratio (115.61 ± 4.38%) (p = 0.004) in all patients. After surgery, inferior oblique muscle underaction was observed in seven and six patients in groups 1 and 2, respectively, which was associated with preoperative extraocular movement limitation and strabismus. Two patients showed diplopia in both groups at the last follow-up; they had inferior oblique muscle underaction but no enophthalmos. Conclusion: Orbital fracture repair with or without inferior oblique muscle reattachment was clinically effective and safe; however, patients with preoperative strabismus and extraocular motility limitation should be informed of the increased risk of postoperative complications.

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Section: Discussioncontrasting

confidence: 64%

“…Seventeen and 23 patients had right and left orbital wall fractures, respectively. The mean follow-up visit was 9 ± 3.47 months (range, [6][7][8][9][10][11][12][13][14][15][16][17]. Patients showed enophthalmos of -1.46 ± 0.25 (range, -5 to 3) mm compared with the normal side.…”

Section: Resultsmentioning

confidence: 99%

Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Park

Choi

2022

OPTH

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“…The full large size implant is sizeable relative to the tight operative space afforded by an inferior transconjunctival inci sion; however, a swinging eyelid approach was only utilized in 21% of cases as the authors preferred to keep the lateral canthus intact whenever possible. Additionally, several groups have re ported induced postoperative diplopia as a result of iatrogenic inferior oblique disruption 24,25 and so generally the authors prefer to keep the inferior oblique muscle attached, which effectively creates 2 operative spaces and prohibits straightforward implant insertion. In 2 cases, the inferior oblique was intentionally di vided and reattached and this was due to surgeon preferenceneither patient had any untoward sequelae from this approach.…”

Section: Discussionmentioning

confidence: 99%

Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene–Titanium Implants

Blessing

Rong

Tse

et al. 2020

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: Complex bony orbital defects are reconstructively challenging due to loss of intraoperative anatomical landmarks and adjacent support. Presized and precontoured porous polyethylene–titanium implants (Medpor Titan 3D Orbital Floor Implant) are designed to reestablish normal orbital floor and medial wall anatomy and are modeled after anatomically averaged orbits. This is the first study to report clinical outcomes with this implant. Methods: This retrospective case series reviewed clinical data and outcomes for patients undergoing orbital reconstruction with a presized and precontoured porous polyethylene–titanium orbital implant from January 2016 to June 2018. Results: A total of 34 orbits of 33 patients were identified (mean age: 43 ± 16 years, 70% men). Most bony defects were a result of trauma and included large orbital floor deformities (100%), medial wall defects (74%), disrupted inferomedial struts (68%), and broken posterior ledges (82%). Symptomatic diplopia (73%) and enophthalmos (89%, mean: 3.7 ± 2.1 mm) were common preoperatively. Many cases were revisions (44%). Mean follow up was 7.8 ± 6.7 months. All patients had improved globe positioning, enophthalmos, and hypoglobus. Seven patients had persistent postoperative diplopia: 6 responded to prism therapy and 1 required strabismus surgery. One patient required retrobulbar hematoma drainage and 1 patient required implant explantation due to chronic infection. Conclusions: Commercially available presized and precon toured porous polyethylene–titanium implants are useful for complex orbital bony defects and can achieve functional improve ments in diplopia, enophthalmos, and extraocular motility with a low incidence of postoperative complications or revisional surgery.

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“…Regarding motility deficits associated with disinsertion or myotomy of the IO during this procedure, they found IO underaction in 50% of patients, although none of the patients were bothered to the point of requiring strabismus surgery. 13 Another case of IO disinsertion during transcaruncular approach for orbital fracture repair lead to an IO palsy which required surgical correction of the persistent hypotropia and incyclotropia. 14 However, other reports of intentional IO disinsertion followed by muscle reposition within the orbit showed no lasting postoperative motility deficits or diplopia.…”

Section: Discussionmentioning

confidence: 99%

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair

Tooley

Levine

Godfrey

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.

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Pseudo-Brown Syndrome: A Potential Ophthalmologic Sequela After a Transcaruncular–Transconjunctival Approach for Orbital Fracture Repair

Cited by 11 publications

References 15 publications

Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut

Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene–Titanium Implants

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair

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