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A. De Giglio, V. Russo, A. Cosma, R. Franco, A. Barone, A. Stella, N. Delle Noci; 10 Years of Follow-Up of a Perspective Study on a New Approach to "Orbital Floor Fractures" With Diplopia. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5256.
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To evaluate our not invasive approach to blow-out fractures with muscle entrapment and to report our results over a 10 years period with 6 months follow-up time.
Precise exclusion standards were adopted:trap-door fracture,just muscle edema without entrapment,lack of diplopia,enophthalmos>2 mm,herniated orbital tissue volume >0.7 ml,not injured sensitiveness.The inclusion standards were: pure blow-out fracture with enophthalmos <2mm, herniated orbital tissue volume <0.7 ml, diplopia, and muscle entrapment.Then we selected 130 patients admitted to the our Department of Ophthalmology and divided them in two groups:Group A, 60 patients treated in 2 weeks with reconstruction of the orbital floor , and Group B, 70 patients treated in 24 h with the traction suture.In the Group A, for the reconstruction of the orbital floor, we first performed, transconjunctivally a blunt dissection to the orbital rim and reposed all herniated tissue, then we inserted and fixed a medpor/porex implant to cover the entire defect; finally we performed the forced duction test.In the Group B, we first tried to establish the amount of the muscular deficit with the forced duction test then we placed a traction suture transconjunctivally accross the insertion of the inferior rectus muscle.In this way the eyeball was kept in elevation by the suture that was taped on the forehead from 5 to 15 days.
The presence of diplopia, enophthalmos, and sensivitiness were investigated in A and B groups.1 month after surgery, the incidence of diplopia was in the Group A (66.7%) higher than the Group B (33.3%).The enophthalmos was absent in the Group A and present in 12.8% patients of the Group B.The sensivitiness post-operation was loosen in 66.7% patients included in the first group, otherwise was present in all of the patients of the second group.6 months after surgery, in the Group A, the diplopia affected 5.3% patients presenting double vision at previous check, and was absent in the Group B.The enophthalmos was absent in the A group and affected just 4 (5.7%) patients included in the Group B.The sensivitiness post-operation was unchanged after the last control in both of the groups.
We use to manage the some well defined orbital floor fracture with this procedure within 24 hours from the trauma and in all those cases with clinical signs of muscle entrapment. The tractional suture technique is able to prevent the permanent deficit of the ocular motility and further surgical procedures on the extraocular muscles to correct the diplopia.
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