Posttraumatic Enophthalmos and Three-Dimensional Imaging

Chapter

Abstract

Enophthalmos following trauma occurs secondary to an increase in orbital volume although traumatic atrophy of soft tissue may play a role [1]. Whether presenting in the acute or chronic phase, such cases can be challenging to evaluate and manage. Patients will report abnormalities in blink, ocular discomfort, visible deformity, or diplopia. Globe projection asymmetry of 2 mm or greater is typically cosmetically noticeable [2, 3]. In this chapter, we review the relevant anatomy of the orbit, the pathophysiology of enophthalmos, mechanisms of injury, evaluation, and management. Other masqueraders of traumatic enophthalmos will be discussed. The use of modern three-dimensional imaging techniques and its role in reconstruction will also be examined.

Keywords

Titanium Migration Depression Titan Neuropathy 

References

  1. 1.
    Manson PN, Grivas A, Rosenbuam A, Vannier M, Zinreich J, Iliff N. Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative computed tomography. Plast Reconstr Surg. 1986;77(2):203–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Dulley B, Fells P. Long-term follow up of orbital blowout fracture with or without surgery. Mod Probl Ophthalmol. 1970;19:467.Google Scholar
  3. 3.
    Osguthorpe JD. Orbital wall fractures: evaluation and management. Otolaryngol Head Neck Surg. 1991;105:702.PubMedGoogle Scholar
  4. 4.
    Mustarde JC. The role of Lockwood’s suspensory ligament in preventing downward displacement of the eye. Br J Plast Surg. 1968;21:73.PubMedCrossRefGoogle Scholar
  5. 5.
    Manson PN, Clifford CM, Iliff NT, Morgan R. Mechanisms of global support and posttraumatic enophthalmos: I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat. Plast Reconstr Surg. 1986;77(2):193–202.PubMedCrossRefGoogle Scholar
  6. 6.
    Resnick JI, Kawamoto Jr HK. Facial fractures. In: Habal MB, Arlyan S, editors. Traumatic enophthalmos. Philadelphia: BC Decker; 1989. p. 155–69.Google Scholar
  7. 7.
    Memon MY, Paine KW. Direct injury of the oculomotor nerve in craniocerebral trauma. J Neurosurg. 1971;35:461–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Mauriello JA, Antonacci R, Mostafavi R, Narain K, Caputo AR, Wagner RS, Palydowicz S. Paresis and restriction of the extraocular muscles after orbital fracture: a study of 16 patients. Ophthal Plast Reconstr Surg. 1996;12(3):206–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Yoon MK, Economides J, Horton JC. Slack extraocular muscles cause diplopia on eccentric gaze in enophthalmos. Vancouver: North American Neuro-Ophthalmological Society; 2011.Google Scholar
  10. 10.
    Seider N, Gilboa M, Miller B, Hadar RS, Beiran I. Orbital fractures complicated by late enophthalmos: higher prevalence in patients with multiple trauma. Ophthal Plast Reconstr Surg. 2007;23(2):115–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Jank S, Schuchter B, Emshoff R, Strobl H, Koehler J, Nicasi A, Norer B, Baldissera I. Clinical signs of orbital wall fractures as a function of anatomic function. Oral Surg Oral Med Oral Pathol. 2003;96(2):149–53.CrossRefGoogle Scholar
  12. 12.
    Ellis III E, El-Attar A, Moos KF. An analysis of 2067 cases of zygomatico-orbital fracture. J Oral Maxillofac Surg. 1985;43:417–28.PubMedCrossRefGoogle Scholar
  13. 13.
    Gassner R, Tarkan T, Hachl O, et al. Cranio-maxillofacial trauma: a 10 year review of 9543 cases with 21067 injuries. J Craniomaxillofac Surg. 2003;31:51–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Sullivan WG. Displaced orbital roof fractures: presentation and treatment. Plast Reconstr Surg. 1991;87(4):657–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Lakits A, Prokesch R, Scholda C, Nowotny R, Kaider A, Bankier A. Helical and conventional CT in the imaging of metallic foreign bodies in the orbit. Acta Ophthalmol Scand. 2000;78:79–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Berkowitz RA, Putterman AM, Patel DB. Prolapse of the globe into the maxillary sinus after orbital floor fracture. Am J Ophthalmol. 1981;91(2):253–7.PubMedGoogle Scholar
  17. 17.
    Abrishami M, Aletaha M, Bagheri A, Salour SH, Yazdani S. Traumatic subluxation of the globe into the maxillary sinus. Ophthal Plast Reconstr Surg. 2007;23(2):156–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology. 2000;107(5):829–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Kum C, McCulley TJ, Yoon MK, Hwang TN. Adult orbital trapdoor fracture. Ophthal Plast Reconstr Surg. 2009;25(6):486–7.PubMedCrossRefGoogle Scholar
  20. 20.
    McCulley TJ, Yip CC, Kersten RC, Kulwin DR. Medial rectus muscle incarceration in pediatric medial orbital wall trapdoor fractures. Eur J Ophthalmol. 2004;14(4):330–3.PubMedGoogle Scholar
  21. 21.
    Brannan PA, Kersten RC, Kulwin DR. Isolated medial wall fractures with medial rectus muscle incarceration. Ophthal Plast Reconstr Surg. 2006;22(3):178–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Dal Canto AJ, Linberg JV. Comparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma. Ophthal Plast Reconstr Surg. 2008;24(6):437–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Simon GJ, Syed HM, McCann JD, Goldberg RA. Early versus late repair of orbital blowout fractures. Ophthalmic Surg Lasers Imaging. 2009;40(2):141–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Matic DB, Tse R, Banerjee A, Moore CC. Rounding of the inferior rectus muscle as a predictor of enophthalmos in orbital floor fractures. J Craniofac Surg. 2007;18(1):127–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Roncevic R, Stajcic Z. Surgical treatment of post-traumatic enophthalmos: a study of 72 patients. Ann Plast Surg. 1992;32:288.Google Scholar
  26. 26.
    Burm JS, Chung CH, Oh SJ. Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg. 1999;103:1839–49.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee WT, Kim HK, Chung SM. Relationship between small-size medial orbital wall fracture and late enophthalmos. J Craniofac Surg. 2009;20(1):75–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Whitehouse RW, Batterbury M, Jackson A, Noble JL. Prediction of enophthalmos by computed tomography after “blow out” orbital fracture. Br J Ophthalmol. 1994;78:618–20.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Fan X, Li J, Zhu J, Li H, Zhang D. Computer-assisted orbital volume measurement in the surgical correction of late enophthalmos caused by blowout fractures. Ophthal Plast Recontr Surg. 2003;19(3):207–11.CrossRefGoogle Scholar
  30. 30.
    Ahn HB, Ryu WU, Yoo KW, Park WC, Rho SH, Lee JH, Choi SS. Prediction of enophthalmos by computer-based volume measurement of orbital fractures in a Korean population. Ophthal Plast Reconstr Surg. 2008;24(1):36–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Raskin EM, Millman AL, Lubkin V, Della Rocca RC, Lisman RD, Maher EA. Prediction of late enophthalmos by volumetric analysis of orbital fractures. Ophthal Plast Reconstr Surg. 1998;14(1):19–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Jin HR, Shin SO, Choo MJ, Choi YS. Relationship between the extent of fracture and the degree of enophthalmos in isolated blowout fractures of the medial orbital wall. J Oral Maxillofac Surg. 2000;58:617–20.PubMedCrossRefGoogle Scholar
  33. 33.
    Kim YK, Park CS, Kim HK, Lew DH, Tark KC. Correlation between changes of the medial rectus muscle section and enophthalmos in patients with medial orbital wall fracture. J Plast Reconstr Aesthet Surg. 2009;62:1379–83.PubMedCrossRefGoogle Scholar
  34. 34.
    Converse JM, Cole G, Smith B. Late treatment of blowout fractures of the orbit. Plast Reconstr Surg. 1961;64:676–88.Google Scholar
  35. 35.
    Pearl RN. Surgical management of volumetric changes in the boy orbit. Ann Plast Surg. 1987;19:349–58.PubMedCrossRefGoogle Scholar
  36. 36.
    McDermott MW, Durity FA, Rootman J, Woodhurst WB. Combined frontotemporal-orbitozygomatic approach for tumors of the sphenoid wing and orbit. Neurosurgery. 1990;26(1):107–16.PubMedCrossRefGoogle Scholar
  37. 37.
    Matsuo K, Hirose T, Furuta S, Hayashi M, Watanabe T. Semiquantitative correction of posttraumatic enophthalmos with sliced cartilage grafts. Plast Reconstr Surg. 1989;83(3):429–37.PubMedCrossRefGoogle Scholar
  38. 38.
    Lee JW. Preplanned correction of enophthalmos using diced cartilage grafts. Br J Plast Surg. 2000;53:17–23.PubMedCrossRefGoogle Scholar
  39. 39.
    Nishi Y, Kiyokawa K, Watanabe K, Rikimaru H, Yamauchi T. A surgical treatment of severe late posttraumatic enophthalmos using sliced costal cartilage chip grafts. J Craniofac Surg. 2006;17(4):673–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Lee JW. Treatment of enophthalmos using corrective osteotomy with concomitant cartilage-graft implantation. J Plast Reconstr Aesthet Surg. 2010;63:42–53.PubMedCrossRefGoogle Scholar
  41. 41.
    Rubin PA, Bilyk JR, Shore JW. Orbital reconstruction using porous polyethylene sheets. Ophthalmology. 1994;10(10):1697–708.CrossRefGoogle Scholar
  42. 42.
    Garibaldi DC, Iliff NT, Grant MP, Merbs SL. Use of porous polyethylene with embedded titanium in orbital reconstruction: a review of 106 patients. Ophthal Plast Reconstr Surg. 2007;23(6):439–44.PubMedCrossRefGoogle Scholar
  43. 43.
    Haug RH, Nuveen E, Bredbenner T. An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg. 1999;57:564–70.PubMedCrossRefGoogle Scholar
  44. 44.
    Rosen CE. Late migration of an orbital implant causing orbital hemorrhage with sudden proptosis and diplopia. Ophthal Plast Reconstr Surg. 1996;12(4):260–2.PubMedCrossRefGoogle Scholar
  45. 45.
    Custer PL, Lind A, Trinkaus KM. Complications of supramid orbital implants. Ophthal Plast Reconstr Surg. 2003;19(1):62–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Tessier P, Rougier J, Hervouet F, et al. Sequelae of orbital trauma. Plastic surgery of the orbit and eyelids [transl by Wolfe SA]. New York: Masson Publishing USA; 1981. p. 99.Google Scholar
  47. 47.
    Grant MP, Iliff NT, Manson PN. Strategies for the treatment of enophthalmos. Clin Plast Surg. 1997;24:539–50.PubMedGoogle Scholar
  48. 48.
    Yeatts RP. Measurement of the globe position in complex orbital fractures: II. Patient evaluation utilizing a modified exophthalmometer. Ophthal Plast Reconstr Surg. 1992;8:119.PubMedCrossRefGoogle Scholar
  49. 49.
    Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg. 1993;119(9):1000–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Bite U, Jackson IT, Forbes GS, Gehring DG. Orbital volume measurements in enophthalmos using three-dimensional CT imaging. Plast Reconstr Surg. 1985;75(4):502–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Fan X, Zhou H, Lin M, Fu Y, Li J. Late reconstruction of the complex orbital fractures with computer-aided design and computer-aided manufacturing technique. J Craniofac Surg. 2007;18(3):665–73.PubMedCrossRefGoogle Scholar
  52. 52.
    Schon R, Metzger MC, Zizelmann C, Weyer N, Schmelzelsen R. Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures. Int J Oral Maxillofac Surg. 2006;35:990–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Guo L, Tian W, Feng F, Long J, Li P, Tang W. Reconstruction of orbital floor fractures: comparison of individual prefabricated titanium implants and calvarial bone grafts. Ann Plast Surg. 2009;63(6):624–31.PubMedCrossRefGoogle Scholar
  54. 54.
    Tang W, Guo L, Long J, Wang H, Lin Y, Liu L, Tian W. Individual design and rapid prototyping in reconstruction of orbital wall defects. J Oral Maxillofac Surg. 2010;68:562–70.PubMedCrossRefGoogle Scholar
  55. 55.
    Klein M, Glatzer C. Individual CAD/CAM fabricated glass-bioceramic implants in reconstructive surgery of the bony orbital floor. Plast Reconstr Surg. 2006;117:565–70.PubMedCrossRefGoogle Scholar
  56. 56.
    Lieger O, Richards R, Liu M, Lloyd R. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg. 2010;12(3):186–91.PubMedCrossRefGoogle Scholar
  57. 57.
    Soparkar CN, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome: a cause of spontaneous enophthalmos. Ophthalmology. 1994;101:772–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Gagnon MR, Yeatts RP, Williams Z, et al. Delayed enophthalmos following a minimally displaced orbital floor fracture. Ophthal Plast Reconstr Surg. 2004;20:241–3.PubMedCrossRefGoogle Scholar
  59. 59.
    Ross JJ, Kersten RC. Late enophthalmos mimicking silent sinus syndrome secondary to orbital trauma. J Craniofac Surg. 2005;16:840–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Montezuma SR, Gopal H, Savar A, Turalba A, Cestari DM, Torun N. Silent sinus syndrome presenting as enophthalmos long after orbital trauma. J Neuroophthalmol. 2008;28:107–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity of California – San Francisco Medical CenterSan FranciscoUSA

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