외상성 안구변위증 25례의 지연교정에 대한 분석 = AN ANALYSIS OF DELAYED CORRECTION OF 25-CASES OF POST TRAUMATIC OCULAR DISPLACEMENT

다국어 초록 (Multilingual Abstract)

Post-traumatic ocular displacement is a potential complication of orbital fracture. This article reviews the causes of this sequelae, describes the preoperative evaluation to delayed correction, surgical techniques and examines the long term results(mean 9.5 months) in 25 patients with post-traumatic ocular displacement for recent 3 years. Among many causes, initial inadequate operation with resultant deformities was the most common contributing factor in our study(56.0%). There were various patterns of initial facial bone fractures, and the orbitozygomatic fractures were the major contributing fracture pattern in post-traumatic ocular displacement(68.0%).
For all patients, we evaluated carefully the three-dimensional positions of globe using facial trisquare and exophthalmometry, and the deformed orbital condition were assessed using cephalometrics, computerized tomography and three-dimensional imaging.
In terms of surgical technique, orbital scar tissue was excised and released, the malunited zygomatic bone was osteotomised and repositioned in 14 cases, and then oculoplasty were done in 28 cases for the restoration of the balance between the orbital content and bony surroundings with permanent correction of traumatic ocular deformities.
The results were satisfactory. The aesthetic problems were corrected or significantly improved in all patients except one(96%). In the functional results, among the 7 patients with diplopia, two were resolved and five were improved. Of 5 patients with decreased visual acuity, 3 were improved. It is concluded that most ocular displacement could be prevented if the surgeon carefully tried to reconstruct the orbit with perfect result in his first operation. And it could be a treatable problem if the surgeon considered the pathologic condition preoperatively, operated complete exposure of the facial skeleton and release of scar tissue, and provided a safe and stable correction.