Expansion Orbitotomy: Another Approach to the Orbital Floor

Expansion Orbitotomy : Another Approach to the orbital floor

Dai Hun, Kang. M.D. Kyungpook National University School of Medicine, Daegu, Korea

Tae Gon Kim, M.D., Sung-Eun Kim, M.D., Jun Ho Lee, M.D. Yong-Ha Kim, M.D., Ph.D.

Young Nam University School of Medicine, Daegu, Korea

 

Introduction:

Surgeons often encounter obstacles reconstructing the orbital floor because of its narrow operative field. The procedure tends to be very difficult when orbital contents are stuck between bone defects. And they are not easily restorable. It could be dangerous and might leave injuries reducing soft tissues by forceps or mosquitos. Tessier's infraorbital marginotomy can be helpful to solve such problems. However, it is too invasive to be performed easily. In this study, we describe a modified version of Tessier's inferior orbitotomy.

 

Methods:

Twenty one patients with entrapment-type fracture were included. On the facial coronal and sagittal planes of computed tomography images, herniated orbital contents and entrapment soft tissues were identified. After subciliary incision and subperiorbital dissection around the adhesion area of the orbital defect site, preoperative design for osteotomy was done on the fractured orbital floor. An osteotomy was performed using a drill to remove the bone fragment (Fig.1). Extreme care was taken not to harm adjacent tissues. Then, the herniated orbital contents were reduced using a periosteal elevator.

Results:

The mean of postoperative follow-up period was ten months (6-12 months). Eight patients had diplopia before the operation and, eleven patients had paresthesia of the ipsilateral cheek. Postoperatively, the diplopia was improved in all patients. At immediate postoperation, one of the patients still had the paresthesia but it was resolved within one month. New paresthesia occurred in another patient after the surgery but it was improved within three months.

Conclusions:

This method is useful when orbital contents are stuck between periorbital bony fragments. This technique has an advantage over the conventional one in that the approach is much simpler and less invasive. Furthermore, excellent exposure of the operation field, protection of soft tissue and safety dissection of infraorbital nerve are additional merits.

 

Please include Images if appropriate:

 

Figure 1 Surgical technique. (Left) Guide hole made by a (Right) Illustration.