Limits...
Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube.

Kim JY, Choi G, Kwon JH - Clin Exp Otorhinolaryngol (2015)

Bottom Line: Enophthalmos resolved postoperatively in four of five patients.During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications.This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT

Objectives: The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach.

Methods: A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained.

Results: In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries.

Conclusion: During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

No MeSH data available.


Related in: MedlinePlus

Illustrations showing the repair of the orbital floor fracture. (A) Note that the fractured fragments of the orbital floor and orbital fat are returned to their original place before the insertion of implants. (B) A silastic sheet (1 mm; arrowhead) is placed under the orbital floor and a bent silicon tube (arrow) is inserted into the maxillary sinus under the silastic sheet via a transantral approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4553356&req=5

Figure 1: Illustrations showing the repair of the orbital floor fracture. (A) Note that the fractured fragments of the orbital floor and orbital fat are returned to their original place before the insertion of implants. (B) A silastic sheet (1 mm; arrowhead) is placed under the orbital floor and a bent silicon tube (arrow) is inserted into the maxillary sinus under the silastic sheet via a transantral approach.

Mentions: Surgical procedures were performed under general anesthesia. Typically, 1% lidocaine with 1:100,000 dilution of epinephrine was injected into the upper gingivobuccal sulcus. A 3- to 4-cm horizontal incision was made just superior to the sulcus. The periosteum and overlying soft tissue were gently elevated from the underlying maxillary bone to the infraorbital foramen using a periosteal elevator. An antral window (2 cm×1.5 cm) was made into the maxillary sinus with an electric saw. The bone fragment was preserved in saline solution for repositioning at the end of surgery. The maxillary sinus and prolapsed orbital contents were visualized employing a 0-degree endoscope, through the antral window. The herniated orbital contents were reduced by digital manipulation or by using surgical instruments like an elevator, without removing the mucosa and fractured bone chip. A silastic sheet (1 mm), slightly larger than the fractured area, was inserted into the maxillary sinus and placed below the orbital floor. A silicon tubing (1 mm in adult and 0.5 mm in pediatric cases) was bent one or two times, and inserted into the maxillary sinus under the silastic sheet (Fig. 1). When placed into the maxillary sinus, the tube recoiled automatically and adjusted to the sinus wall to firmly support the reduced orbital floor with its elasticity (Fig. 2). Care was taken not to obstruct the natural ostium of the maxillary sinus (Fig. 3). A forced duction test was performed to confirm correct positioning of the orbital floor and to avoid entrapment of the orbital contents before closing. The antral wall fragment, stored in saline, was fixed in its original position using a plate and screws. The gingivobuccal incision was closed, and postoperative antibiotics were continued for 14 days. The silastic sheet and tube were removed 6 to 8 weeks postsurgery under local anesthesia through the same antral maxillary window, created during the first surgery (Fig. 4). The second surgery was performed under general anesthesia in all children and some adults.


Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube.

Kim JY, Choi G, Kwon JH - Clin Exp Otorhinolaryngol (2015)

Illustrations showing the repair of the orbital floor fracture. (A) Note that the fractured fragments of the orbital floor and orbital fat are returned to their original place before the insertion of implants. (B) A silastic sheet (1 mm; arrowhead) is placed under the orbital floor and a bent silicon tube (arrow) is inserted into the maxillary sinus under the silastic sheet via a transantral approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553356&req=5

Figure 1: Illustrations showing the repair of the orbital floor fracture. (A) Note that the fractured fragments of the orbital floor and orbital fat are returned to their original place before the insertion of implants. (B) A silastic sheet (1 mm; arrowhead) is placed under the orbital floor and a bent silicon tube (arrow) is inserted into the maxillary sinus under the silastic sheet via a transantral approach.
Mentions: Surgical procedures were performed under general anesthesia. Typically, 1% lidocaine with 1:100,000 dilution of epinephrine was injected into the upper gingivobuccal sulcus. A 3- to 4-cm horizontal incision was made just superior to the sulcus. The periosteum and overlying soft tissue were gently elevated from the underlying maxillary bone to the infraorbital foramen using a periosteal elevator. An antral window (2 cm×1.5 cm) was made into the maxillary sinus with an electric saw. The bone fragment was preserved in saline solution for repositioning at the end of surgery. The maxillary sinus and prolapsed orbital contents were visualized employing a 0-degree endoscope, through the antral window. The herniated orbital contents were reduced by digital manipulation or by using surgical instruments like an elevator, without removing the mucosa and fractured bone chip. A silastic sheet (1 mm), slightly larger than the fractured area, was inserted into the maxillary sinus and placed below the orbital floor. A silicon tubing (1 mm in adult and 0.5 mm in pediatric cases) was bent one or two times, and inserted into the maxillary sinus under the silastic sheet (Fig. 1). When placed into the maxillary sinus, the tube recoiled automatically and adjusted to the sinus wall to firmly support the reduced orbital floor with its elasticity (Fig. 2). Care was taken not to obstruct the natural ostium of the maxillary sinus (Fig. 3). A forced duction test was performed to confirm correct positioning of the orbital floor and to avoid entrapment of the orbital contents before closing. The antral wall fragment, stored in saline, was fixed in its original position using a plate and screws. The gingivobuccal incision was closed, and postoperative antibiotics were continued for 14 days. The silastic sheet and tube were removed 6 to 8 weeks postsurgery under local anesthesia through the same antral maxillary window, created during the first surgery (Fig. 4). The second surgery was performed under general anesthesia in all children and some adults.

Bottom Line: Enophthalmos resolved postoperatively in four of five patients.During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications.This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT

Objectives: The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach.

Methods: A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained.

Results: In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries.

Conclusion: During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

No MeSH data available.


Related in: MedlinePlus