ASOPRSFall Scientific SymposiumSyllabus
57
Orbit Session I
Moderator: Jennifer A. Sivak-Callcott,MD
1:00pm
SecondaryOrbital Reconstruction inPatientswithPriorOrbital FractureRepair
JaneS. Kim, BradfordW. Lee, RichardScawn, BobbyS. Korn, DonO. Kikkawa. Divisionof Oculofacial Plastic andReconstructive
Surgery, Department of Ophthalmology, Shiley EyeCenter, UCSanDiego, La Jolla, CA, UnitedStates
Introduction:
Performing secondary orbital reconstruction on inadequately repaired orbital fractures is challenging, and controversy
exists regarding thewisdom of further surgical intervention. Nonetheless, patientsmay have debilitating functional and cosmetic
deficits,which if addressed could result in significant improvements in quality of life.This study evaluates clinical characteristics and
post-operative outcomes of secondary orbital reconstruction in patientswho underwent suboptimal primary orbital fracture repair.
Methods:
A retrospective review yielded 14 patientswho underwent secondary orbital reconstruction following suboptimal primary
orbital fracture repair. Indications for secondary surgery, interval between primary and secondary surgery, and complications of
secondary surgerywere analyzed. Primary outcomes included post-operative changes in enophthalmos, hypo- or hyperglobus,
superior sulcus deformity, extraocularmotility (scale: 0 to -4), and compressive optic neuropathy. Patient-reported functional and
cosmetic outcomeswere also assessed on a five-point analog scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied).
Globe position andmotilitywere compared pre- and post-operatively using paired t-tests for statistical analysis.
Results:
Indications for secondary surgery included enophthalmos, hypo- or hyperglobus, superior sulcus deformity, restrictive
strabismus, painwith extraocularmovements, and compressive optic neuropathy. Prior to secondary orbital reconstruction, 13/14
cases had enophthalmos, 11/14 had hypoglobus, 1/14 had hyperglobus, 10/14 had a superior sulcus deformity, 13/14 had
restricted supraduction, and 7/14 had restricted infraduction.Mean pre-operative enophthalmoswas 4.3+/- 2.5mm, andmean
pre-operative hypoglobuswas 3.1+/- 1.5mm. Secondary reconstruction resulted inmean enophthalmos reduction of 3.39+/-
1.4mm (p<0.001),mean hypoglobus reduction of 2.86+/- 1.4mm (p<0.001), and hyperglobus reduction of 1mm (n=1).All ten
patients had resolution of their superior sulcus deformity. Of 13 caseswith restricted ocularmotility, six had complete resolution, and
seven had partial resolution following secondary orbital reconstruction.Mean improvement in supraduction and infraductionwas
1.77 points (p<0.001) and 1.43 points (p=0.025), respectively. Subjectively, 64% of patients reported being “very satisfied,”
29%were “satisfied,” and one patient was “neutral” regarding both functional and aesthetic post-operative outcomes. Complications
included persistent mydriasis (1/14) and prolonged chemosiswhich resolved (1/14). 5/14 patients had infraorbital hypesthesia
pre-operatively, but this did not worsen after secondary surgery.
Conclusions:
Secondary orbital reconstruction following
suboptimal primary orbital fracture repair presents
numerous challenges due to implant malposition, scarring,
and tissue injury.This study demonstrates that secondary
orbital reconstruction can achieve excellent functional and
cosmetic outcomeswithminimal complications and high
patient satisfaction. Statistically significant improvements
in enophthalmos, hypoglobus, superior sulcus deformity,
and restrictive strabismuswere observed and positively
correlatedwith patient-reported outcomes. Secondary
orbital reconstruction of orbital fractures should be strongly
considered as a treatment optionwhen clinically indicated.
References:
JordanDR,Mawn L. Blowout fractures of
the orbit. In: Black EH, Nesi FA, Calvano CJ, GladstoneGJ, LevineMR, ed. Smith andNesi’s Ophthalmic Plastic and Reconstructive
Surgery. 3rd ed. NewYork: Springer, 2012:243-63.
DetailedProgram
—Thursday,October 16, 2014
