Lyo-Dura를 이용한 Orbital Floor Fracture의 정복술

이희철,이희원 인제대학교 1982 仁濟醫學 Vol.3 No.4

최근 우리나라는 물론이고 전세계적으로 교통사고등 현대산업사화에서 빈발하는 각종사고로 인하여 악안면 부위의 골절환자가 점증하고 있는 바 이에 대한 적절한 진단과 처치가 구강외과 영역에서 중요한 문제로 대두되고 있다. 이에 본 논제에서는 facial bone fracture가 있을때에 orbital floor를 Lyodura를 이용해서 reconstruction 하는 방법에 대해서 논하고자 한다. Orbital bone trauma, maxillofacial bone fracture, and soft tissue injury are often progressive components of a single or multiple injury pattern. Facial lacerations associated with underlying skeletal damage have been described previously; but its diagnostic significance seldom has been appreciated. Blunt trauma to the region of infraorbit may result in a spectrum of injuries, ranging from minor lacerations or eccymosis to compound fractures. The extent of soft-tissue and skeletal damage is related to the force and direction of impact; a relatively large force seems to be required to produce a infra-orbital-floor fracture, whereas lesser impacts generally result only in soft-tissue injury. When the facial bone is fractured, especially commiunted fracture of the orbital-floor, the bony surface is lost and opened to the maxillary-sinus cavity. Therefore the orbital fascia, the periosteum and the muscle is herniated partially into the cavity. If oral-surgern did not reconstruct the area perfectly, the permanent diplopia is caused by compress the oblique inferior muscle and the rectus inferior muscle. Then we reconstruct the fractured orbital-floor by use of the LYO-DURA effectively. This report describes representative patients with fractures of the infraorbital floor and of the maxillo-facial bone secondary to maxillo-facial-region trauma and suggests a protocol for efficient diagnosis and surgical new technique.

뚜껑문 안와저 골절에 있어서 망상 흡수성 판을 이용한 관혈적 정복술 및 내고정술

권유진,김지훈,황재하,김광석,이삼용,Kwon, Yu-Jin,Kim, Ji-Hoon,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. Methods: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevatordepressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. Results: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. Conclusion: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.

Effects of infraorbital nerve's anatomical course on the fracture pattern of the orbital floor

Kim, Junhyung,Park, Sang Woo,Choi, Jaehoon,Jeong, Woonhyeok,Kim, Ryeolwoo Elsevier 2018 Journal of plastic, reconstructive & aesthetic sur Vol.71 No.4

<P><B>Summary</B></P> <P>In this study, details of the infraorbital nerve's (ION's) anatomical course variants were compared using computed tomography (CT), and relationships between the variants and fracture patterns in the orbital floor were investigated. Fifty-two normal individuals and 50 patients with unilateral isolated orbital floor fractures were enrolled in this study. Four measurements in normal individuals and five measurements in fracture patients were obtained in parasagittal sections. The anatomical variations of the ION were categorized into three types according to the classification by Ferences et al. Among the normal individuals, 42 orbits were classified as type 1 ION, 48 orbits as type 2, and 14 orbits as type 3. The distance from the inferior orbital rim to the upper border of the inferior orbital foramen and the length of descension portion of the ION in type 1 ION were significantly shorter than in type 2 and type 3 IONs. In patients with orbital floor fractures, the distance from the inferior orbital rim to the upper border of the inferior orbital foramen was positively correlated with herniation level of bone and soft tissue. The ION had three anatomical variants according to the degree of descension in the anterior portion of the orbit. When fracture of the orbital floor occurs in patients with type 1 ION, inferior displacement of the fractured orbital bone and orbital soft tissue may be less severe than in patients with other ION types.</P>

상악동 전벽 이식술을 이용한 안와의 True Blow-out Fracture 처치

이재휘(Jae Hwy Lee),배정수(Jung Soo Bae),장동수(Dong Soo Jang) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.3

Bony anatomy of the orbit is composed of frontal bone, maxilla, zygomatic bone, sphenoid, ethmoid, lacrimal bone, and palatine bone. Frontal bone, maxilla, and zygomatic bone are particularly strong, but the walls of funnel-shaped orbit consist in part of very thin bony lamellae, with only little resistance to trauma. These anatomic factors explain the very special fracture mechanisms that prevail in the orbital region, especially true blow-out fracture of the orbital floor. In 1957, Smith and Regan originated the term blow-out fracture to describe a specific type of fracture of the orbital floor without fracture of the orbital rim and with entrapment of one or more orbital soft tissue structures, thus limiting vertical ocular mobility and causing diplopia and enophthalmos. At least four methods of rebuilding the orbital floor are commonly employed. These include repositioning of the displaced bones ; use of alloplastic graft material such as Marlex mesh, Silastic, and Teflon ; autogenous bone grafts ; homografts such as lyophilized dura. This report presents 3 cases of true blow-out fracture of the orbital floor that was treated by autogenous bone graft, especially thin transplants from anterior wall of the maxillary sinus.

안와하벽골절 16개월 이후에 발생한 지연성 복시 1예

노웅재,박태정,권재환,문정환 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.8

Ocular symptoms related to orbital fracture occur immediately after the fracture in most cases. However, authors experienced a delayed onset diplopia occurred 16 months after orbital floor fracture. A 19-year-old man, who had right orbital floor fracture 16 months ago, presented with diplopia of upward gaze. At the time of the fracture, no surgery was performed because the fracture was minimal and there were no particular symptoms. Physical examinations revealed a minor ocular motility restriction of upward gaze, but orbital floor showed no definite interval change on computed tomography. Severe adhesion between the orbital fat tissue and orbital floor was noted intraoperatively and the adhesion was dissected. After the operation, the patient showed remarkable improvement in diplopia and restriction of the ocular motility.

眼窩粉碎骨折의 診斷과 治療 : 眼科的 合病症을 中心으로 Specifically Concerning the Ocular Complication

李熙哲,姜信益 인제대학교 1985 仁濟醫學 Vol.6 No.2

안와분쇄골절(Orbital Blow-out fracture)의 존재와 그 병태에 관한 최초의 언급은 1889年 Lang氏에 의해서 외상성 안구 함몰(Traumatic Enopthalmos)라고 불리면서였으며 1943年 King氏와 Samuel氏는 外力이 안구를 통하여 안와벽이 전달되어 골절이 유발된다는 작용기전을 설명하였고 1957年 Smith氏와 Regan氏는 그 기전이 外力의 직접 전달이 아니라 안압의 상승에 의한다는 것을 사체 실험으로 증명하였다. 그러나 blow-out fracture時 안구운동장애, 복시, 시력 감퇴, 안구 함몰의 치료에 관한 언급은 1957年 Converse氏와 Smith氏에 의하여 外科的 方法으로 Entrap된 연조직을 release시키고 안와 하벽을 재건하는 술식이 도입되었으며 Blow-out fracture라는 용어를 처음으로 사용하게 되었다. 그후, 진단 방법과 수술 방법이 개선되어 현재에 이르고 있으나 우리의 현실에 있어서는 그 개념의 혼동이 존재하고 있어 많은 환자들이 적절한 치료를 받지 못하고 있는 것이 사실이다. 이에 本人은 1981年 7월부터 1984年 6月 30日까지 本院에 내원한 Mid-facial fracture 89 Case를 주 대상으로 Blow-out fracture時 시신경 조직 손상에 의한 시력의 기능적 이상안모의 심미적 손상의 예방 및 치료에 관한 통일적인 접근법을 모색하고자 한다. Blowout fracture of the orbit was described at first in 1889 by Lang, and surgical correction of the blowout fracture was performed at first in 1957 by Converse. The concept in the diagnosis and treatment of the blowout fractures was reviewed by literatures and specifically the ocular complications in the periorbital bone fractures were studied. The main signs and symptoms of the blow- out fracture of the orbit are enophthalmos, vertical diplopia and ocular motility limitation and the corrective surgery is directed to the disengagement of the entraptted orbital fat and muscles, and reconstruction of the orbital floor with allogenic or autogenic graft materials. We used lyophilized dura(Lyodura) in the reconstruction of the fractured orbital floor, and obtained good results. The cases seen and treated in the Dept.of Oral and Maxillofacial Surgery, Inje Medical College Paik Hospital were reviewed. In 89 midfacial fractures, blow-out fractures were 14 cases (15.7%). Of the 89 midfacial fractures patients 19 patients had notable ocular complications and 7 patients lost their vision due to the global rupture and direct or indirect optic nerve injuries. In the midfacial fractures including the blowout fractures, there was relatively high incidence of ocular and neurological complications, so systematic approach through the team approach including oral surgeon, ophthalmologist and neurosurgeon should be emphasized, and then the patients would have better prognosis.

후방까지 연장된 안와하벽골절에서 안구함몰 예방을 위한 Medpor® 내고정술

석정훈,지소영,김태범,양완석 대한두개안면성형외과학회 2008 Archives of Craniofacial Surgery Vol.9 No.2

Purpose: The purpose of this study is to evaluate the effectiveness of internal fixation method of MedporⓇ implant with BioSorbTMFX screw which is used for prevention of enophthalmos in posteriorly extended large orbital floor fracture. Methods: From Jun. 1997 to Dec. 2007, 21 patients who were diagnosed with posteriorly extended large orbital floor fractures were classified into two groups. One group(n=11) had undergone reduction surgery with regular MedporⓇ sheets without any fixation method, while the other group(n=10) had their MedporⓇ sheets fixed with the BioSorbTMFX screws. The two groups were evaluated by comparison of their enophthalmos degree and effectiveness. Results: In the non-fixation group, six patients had enophthalmos preoperatively and three of them showed persistent enophthalmos postoperatively. In postoperative CT examination, displacement of MedporⓇ implant with soft tissue impaction into maxillary sinus was observed in the patients. In the screw fixation group, three patients had enophthalmos preoperatively, but none of them suffer from complication such as residual enophthalmos, soft tissue impaction, muscle entrapment or optic nerve compression postoperatively. Received July 31, 2008 Revised September 11, 2008 Accepted September 19, 2008 Address Correspondence: Wan Suk Yang, M.D., Department of Plastic and Reconstructive Surgery, DongKang General Hospital, 123-3 Taewha-dong, Jung-gu, Ulsan 681-320, Korea. Tel: 052) 241-1326/Fax: 052)241-1324/E-mail: artpsyang@yahoo.co.kr *본 논문은 2007년 11월 대한성형외과학회 제63차 추계학술대회에서 포스터로 발표되었음. Conclusion: Internal fixation method of MedporⓇ implant with BioSorbTMFX screw on the medial surface of orbital floor provides firm stabilization of implants and surrounding soft tissues and can be an effective option especially when postoperative implant displacement or malposition was expected.

안와골 하벽 파열골절의 평가에서 시상면 CT의 유용성

최찬,김용하,최재원 대한두개안면성형외과학회 2007 Archives of Craniofacial Surgery Vol.8 No.2

Optimal diagnostic tool of facial bone fractures is computed tomography(CT). When we diagnosed the facial bone fracture, we routinely used axial & coronal view of CT. But, development of software related CT enabled the application of various views recently. The purpose of this study is to evaluate about usefulness of sagittal view of the CT. Group I was the axial & coronal views about 15 patients with orbital floor fracture. Group II was the axial, coronal & sagittal views about same 15 patients. We asked 4 senior residents of department of plastic reconstructive surgery & ophthalmology, Yeungnam university hospital question about their confidence and usefulness. Compared with group II to group I, group II was more useful result. Using Pearson's chi-square test, statistical significance was checked (p<.05) about almost questions. It means that sagittal view is useful tool for orbital floor fracture.

소아의 안와바닥골절(White-eye blowout fracture)에 있어 조기 정복술

박지훈,양호직,김종환 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.1

Purpose: 'White-eye blowout' fracture is often occur in young patients and defined as blow out fracture with little or no clinical sign of soft tissue trauma such as edema,ecchymosis, but with marked motility restrictions in vertical gaze. In this conditions, immediate operation is essential. We reported the clinical investigation study of these cases about clinical symptoms and radiologic findings and introduce our experiences about immediate operations in 'white-eye blowout' fractures. Methods: From January 2008 to December 2009, nine pediatric patients who were diagnosed as pure white-eye blowout fractures were involved this study. Patients with other facial bone fractures or with poor general medical condition were excluded. In all cases, we performed immediate operation within 48 hours. Results: All patients had diplopia, vertical gaze restriction or systemic symptoms. Six patients had nausea, vomiting and syncope caused by oculocardiac reflex. In all patients,preoperative symptoms were improved after immediate operation. There were no postoperative complications such as infection, hematoma or wound dehiscence. Conclusion: When we meet the young patients with history of periocular trauma, with little or no soft tissue trauma signs, but with marked vertical gaze restriction or general symptoms caused by oculocardiac reflex, we should immediately examine by facial bone computed tomography and refer the patient to ophthalmologist for ophthalmic evaluations. If patient is diagnosed as orbital floor fracture with entrapped muscle or soft tissue, the earlier surgical reduction get better clinical outcomes. (J Korean Cleft Palate Craniofac Assoc 11: 7, 2010)

안와하벽재건술 후 발생한 지연성 눈뒤출혈: 증례보고

이승우,최영웅,남상현,김훈,Lee, Seung-Woo,Choi, Young-Woong,Nam, Sang-Hyun,Kim, Hoon 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. Methods: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. Results: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. Conclusion: Delayed retrobulbar hemorrhage is rare but vision-threatening. Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.