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Type: Journal article
Title: The transcaruncular approach to orbital fracture repair: Ophthalmic sequelae
Author: Malhotra, R.
Saleh, G.
deSousa, J.
Sneddon, K.
Selva-Nayagam, D.
Citation: Journal of Craniofacial Surgery, 2007; 18(2):420-426
Publisher: Lippincott Williams & Wilkins
Issue Date: 2007
ISSN: 1049-2275
Abstract: The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.
Keywords: Lacrimal Apparatus
Vision Disorders
Conjunctival Diseases
Eye Hemorrhage
Eyelid Diseases
Orbital Fractures
Ophthalmologic Surgical Procedures
Fracture Fixation, Internal
Retrospective Studies
Aged, 80 and over
Middle Aged
DOI: 10.1097/scs.0b013e31803384c2
Appears in Collections:Aurora harvest
Surgery publications

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