Rekonstrukce izolovaných zlomenin spodiny očnice nazoseptální chrupavkou

Title in English Reconstruction of Isolated Orbital Floor Fractures by Nasoseptal Cartilage


Year of publication 2019
Type Article in Periodical
Magazine / Source Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
MU Faculty or unit

Faculty of Medicine

Keywords orbital fractures; blow-out fracture; orbital floor; orbital reconstruction
Description Our study objective was to evaluate radiological criteria for indication surgery and clinical outcomes thereafter. Material and methods A retrospective monocentric study of 53 patients who have done the isolated orbital floor fracture reconstruction during the time span 1/1/2006-31/12/2016 at the Clinic of Otolaryngology Head and Neck Surgery St. Anne’s University Hospital, Brno. Evaluated parameters: trauma cause, clinical symptoms, evaluation of CT parameters (MH index, RF index, MRI index), time interval from trauma to operation, complications. Results Trauma cause: an assault 30/53 (57%), a fall 14/53 (26%), sport 4/53 (7%), road traffic accident 4/53 (7%), accident at work 1/53 (2%). Clinical symptoms: eyelid haematoma and/or swelling 53/53 (100%), diplopia 29/53 (55%), emphysema 29/53 (55%), infraorbital nerve hypoesthesia 4/53 (7%). Radiological report of the CT: RF index - defect length more than half of the orbital floor length: 49/53 (92%); defect length less than half of the orbital floor length: 4/53 (7%). MH index (maximum height of periorbital herniation): mean value 9,0 mm (2,8-14,2 mm), MRI index (rectus inferior muscle index): less than 1,5 15/53 (28%), more than 1,5 38/53 (72%). Time interval from trauma to operation: mean value 11 days (3-21 days). Complication 6 weeks postoperatively: diplopia 4/53 (7%), ectropion 2/53 (4%), enophtalmos 0/53 (0%), visual damage 0/53 (0%). Conclusion The choice between the surgical or conservative management of the isolated orbital fracture is a key factor to ensure a good therapeutic result. The evaluation of CT findings is crucial to the decision-making process. The key radiological parameters are the standardized assessment of the orbital floor defect size (RF index), orbital tissue herniation (MH index) and the assessment of damage to the intraorbital muscles (MRI index). As demonstrated by the results of our analysis, surgical reconstruction of the orbital floor by nasoseptal cartilage represents a highly effective and safe method.

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