Reconstruction of medial orbital wall using a retrocaruncular approach

Pedemonte, Christian; Muñoz, Tamara; Valenzuela, Katherine; Díaz, Marlene; González, L. Edgardo; Vargas, Ilich

doi:10.1016/j.jcms.2018.08.004

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…About this, there are different authors who recommend to not suture the transconjunctival approach because it reduces the operative time and favors the drainage of the post-operative edema. 13 Contrary to this, and based on our own experience, we recommend the use of absorbable suture to close up the transconjunctival approach, as it brings benefits for the patient such as reducing not only post-operative bleeding but the risk of infection of the surgical wound. In addition to this, not suturing the transconjunctive surgical wound can produce the adhesion of clots in the conjunctival area, making necessary the constant cleaning of the wound and increasing the hospitalization time for the patient.…”

Section: Discussionmentioning

confidence: 99%

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

Pérez

Correa²,

Fuentes

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Study Design: A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. Objective: The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. Method: The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. Conclusions: This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

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Section: Discussionmentioning

confidence: 99%

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

Pérez

Correa²,

Fuentes

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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“…More specifically, after periosteum incision, a subperiosteal dissection is carried. Even though using a transconjunctival approach usually means encountering and interfering in the lower oblique muscle, this one can be displaced and/or risen or maintained without damage to it, especially when there is no involvement of the medial orbital wall [20]. After exposure of the orbital floor defect with identification and preservation of the inferior oblique muscle and the inferior rectus muscle, the customized device was placed on the defect and further fixed with 1.5 mm diameter screws as needed.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Delayed Orbital Floor Reconstruction Using Mirroring Technique and Patient-Specific Implants: Proof of Concept

D’Alpaos,

Badiali,

Ceccariglia

et al. 2024

JPM

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Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3–6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction.

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“…In this presented analysis of pure ZMO fracture, no cases with additional medial orbital wall fractures have been included. This exclusion was performed to reduce the bias increase in double vision and the complexity of surgical exploration and repair [20,21].…”

Section: Limitationsmentioning

confidence: 99%

Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases

Ritschl

Wittmann

Bomhard

et al. 2022

JCM

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Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0–361.0) and a median postoperative hospital stay of three days (0–25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.

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Reconstruction of medial orbital wall using a retrocaruncular approach

Cited by 9 publications

References 24 publications

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

Delayed Orbital Floor Reconstruction Using Mirroring Technique and Patient-Specific Implants: Proof of Concept

Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases

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