The Journal of Craniofacial Surgery
Brief Clinical Studies
presence of a prosthetic valve in the brain because of a previous hydrocephalus episode (Figs. 1 and 2). Volumetric increase and vascular alterations in jugal mucosa, buccal vestibule, oral floor, and gingival hyperplasia with discreet vascular hyperplasia were also observed. Those clinical manifestations are in accordance with other studies.6,9 The dental treatment of those patients includes a complete anamnesis considering the principal complaint, the history of actual disease, medical history, systems reviewing, medications intake, and the investigation of previous bleeding in the region of the lesion(s).6 Additionally, intraoral and extraoral examinations evaluating the treatments required (restorative, surgical, periodontal, endodontic, and other treatments) associated with image examinations (computed tomography scan, periapical, and panoramic radiographies) are essential for SWS diagnosis and treatment planning.6 Also, the hemostasis of patients with SWS can be a significant problem when a surgery is planned. To the authors’ best knowledge, there are few studies reporting the risk of bleeding in patients with required endodontic treatments. Some authors reported a case report of a patient with PWS and an endodontically affected central incisor (tooth 21).6 These authors conducted a conventional endodontic treatment with satisfactory clinical outcomes, showing that the endodontic treatment is a feasible alternative in comparison to dental exodontias, because the surgery in these patients requires hospitalization and a multidisciplinary team prepared for their treatment.10
CONCLUSIONS Within the limitations of the present case report, it might be concluded that clinicians must be attentive to the presence of vascular malformations in the head and neck region and also have the expertise to perform emergency treatments in patients with those conditions. The endodontic treatment in patients with SWS is feasible and safe, and it might be an alternative to surgical treatments because patients may experience hemorrhages or undergo treatments that require multidisciplinary care and hospitalization.
REFERENCES 1. Comi AM. Presentation, diagnosis, pathophysiology, and treatment of the neurological features of Sturge-Weber syndrome. Neurologist 2011;17:179 2. Neville BW, Damm DD, Allen CM, et al. Tumors of soft tissues: Oral and maxillofacial pathology. Rio de Janeiro: Guanabara Koogan 2004 3. Alkonyi B, Chugani HT, Karia S, et al. Clinical outcomes in bilateral Sturge-Weber syndrome. Pediatr Neurol 2011;44:443 4. Piram M, Lorette G, Sirinelli D, et al. Sturge-Weber syndrome in patients with facial port-wine stain. Pediatr Dermatol 2012;29:32 5. Gontijo B, Pereira LB, Silva CMR. Malformac¸o˜es vasculares. An Bras Dermatol 2004;79:7 6. Suprabha BS, Baliga M. Total oral rehabilitation in patient with portwine stains. J Indian Pedod Prev Dent 2005;23:99 7. Caiazzo A, Mehra P, Papageorge MB. The use of preoperative percutaneous transcatheter vascular occlusive therapy in the management of Sturge-Weber syndrome: report of a case. J Oral Maxillofac Surg 1998;56:775 8. Zhou Q, Yang XJ, Zheng JW, et al. Hemangioma concurrent with arteriovenous malformation in oral and maxillofacial region: report of a case and review of the literature. J Oral Maxillofac Surg 2011;69:1100 9. De Benedittis M, Petruzzi M, Pastore L, et al. YAG laser for gingivectomy in Sturge-Weber syndrome. J Oral Maxillofac Surg 2007;65:314 10. Montegomery S. Endodontic treatment involving intraoral nevus flammeus. J Endod 1979;5:63
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Volume 26, Number 4, June 2015
Simple Repair of a Blow-Out Fracture by the Modified Caldwell–Luc Approach Min Woo Park, DDS, MSD, Soung Min Kim, DDS, MSD, Emmanuel Kofi Amponsah, DDS, PhD,y and Suk Keun Lee, DDS, MSDz Abstract: Here we report a patient with a blow-out fracture of the orbital floor that was treated by an intraoral transmaxillary approach. This 38-year-old man suffered a sudden blow to the periorbital area, which caused prolapse of the orbital contents into the maxillary sinus. The modified Caldwell–Luc approach was used to repair the orbital blow-out fracture and the maxillary sinus during was packed with Frazin gauze for 7 days to prevent recurrence of the prolapse. This was an easy and minimally invasive technique for the management of a blow-out fracture of the orbital floor. Key Words: Blow-out fracture, modified Caldwell–Luc approach
INTRODUCTION
O
rbital floor blow-out fractures often result in prolapse of the orbital contents into the maxillary sinus.1 Although the first report of a blow-out fracture was in 1957,2 controversy remains regarding methods for surgical treatment, including the best approach to the orbit. Traditionally, a transorbital approach to the orbital floor via various lower eyelid incisions has been used in the field of plastic surgery.3 However, subciliary and transconjunctival approaches have high incidences of cosmetic complications.4 A transmaxillary approach to the orbital floor was first reported in the 1972 by Walter5 and became well-established, thanks to advances in endoscopic sinus surgery.6 However, controversy remains concerning the method for support of the orbital floor after elevation of the orbital contents. At the time of this report we use Frazin gauze packing to support the orbital floor for 7 days; this technique is simple and minimally invasive.
CASE REPORT A 38-year-old man fell and hit his face on the floor and visited the department of oral and maxillofacial surgery with ecchymosis of the From the Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea; yDepartment of Oral and Maxillofacial Surgery, Brong Ahafo Regional Hospital, Sunyani, Ghana; and zDepartment of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. Received December 18, 2014. Accepted for publication January 29, 2015. Address correspondence and reprint requests to Dr Soung Min Kim, DDS, MSD, Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 110-768, Korea; E-mail: [email protected] This research was supported by the International Research & Development Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Plannig (Grant number: 2014K1A3A9A01033785) The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001698 #
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
FIGURE 1. The coronal computed tomographic view, preoperative depressed orbital floor with hematoma and sinusitis (A), postoperative 2 years’ view (B).
left periorbital area and diplopia on upward gaze. On examination, upward gaze was limited on the left side, and he had decreased sensation of his left infraorbital area. Water’s view and computed tomography revealed a blow-out fracture with depression of the orbital floor. The orbital rim was intact (Fig. 1A). On the 3rd day after trauma, an operation was performed under general anesthesia. A round shaped bony window of 1 cm diameter was made in the anterior wall of the maxillary sinus using a small round bur. The bony window was secured with a titanium miniplate and 3 miniscrews and removed to be kept separately (Fig. 2). The orbital floor, exposed orbital contents, maxillary sinus ostium, and infraorbital nerve were inspected with a sinus endoscope through both this hole and the nasal cavity (Fig. 3). Although gentle pressure was applied to the herniated orbital soft tissue using a cotton ball held in place with a small mosquito clamp and sinus forceps, forced duction testing was performed to confirm proper reduction. The maxillary ostium was enlarged by an endonasal approach with a sinus endoscope. Then longitudinally folded Frazin gauze was packed into the maxillary sinus and 1 side of the gauze was pulled into the nasal cavity through the enlarged maxillary ostium. The bony window was placed in the original position and fixed with a miniplate and screws (Fig. 2). The patient was instructed to elevate his head at all times and maintain the orthostatic position. Eight days after the operation, the Frazin gauze was removed via the maxillary ostium on an outpatient basis. Postoperative Water’s radiographs were taken at 1 day, 2 weeks, and 6 weeks after the operation to check for recurrent prolapse of the orbital contents, and the patient was followed for 2 years. The enophthalmos and diplopia were corrected and postoperative computed tomography and radiographs revealed the reconstructed orbital floor to be in the proper position throughout the follow-up period without maxillary sinusitis over the 2 years of follow-up (Fig. 1B).
DISCUSSION A blow-out fracture is a downwardly displaced fracture of the orbital rim or floor resulting in increased orbital volume due to the blunt ocular trauma. A routine transorbital approach to the orbital floor via several lower eyelid incisions has been applied; however,
FIGURE 2. Intraoperative photograph showing the repositioned anterolateral wall of the maxillary sinus fixed with microplate and 3 screws.
FIGURE 3. Schematic drawing of endoscopic assisted modified Caldwell–Luc procedure used in this case report.
#
2015 Mutaz B. Habal, MD
Brief Clinical Studies
it has many limitations such as optic nerve damage during exploration of the posterior aspect, cosmetic problems, and conjunctival damage.3 On the contrary, the transmaxillary Caldwell–Luc approach has some advantages such as good visualization, precise confirmation of a blow-out fracture, easy management of entrapped periorbital tissue, and no visible scarring.7 We made the window on the anterolateral wall of the maxillary sinus as in the Caldwell–Luc procedure. The lateral window was made with a very small round bur and was repositioned with titanium miniplate fixation to avoid postoperative scarring and postoperative maxillary cysts. Enlargement of the patient’s own osteomeatal unit using a nasal endoscope instead of an inferior osteotomy as in the Caldwell–Luc procedure has excellent results in terms of physiologic sinus function. There are many substitutive implant materials used to support the orbital floor after elevation of the orbital contents. Autogenous bone,8 lyophilized cartilage or dura,9 sliced costal cartilage,10 silastic sheets,11 titanium mesh,12 MEDPOR,13 or resorbable Plate14 are all been used. In this modified Caldwell-Luc procedure, we used Frazin gauze to support the orbital floor and keep it in the maxillary sinus over the course of 8 days. There were no complications in this patient, complete resolution of the preoperative diplopia was achieved, and no late-developing enophthalmos was seen. This endoscopic-assisted modified technique is easy and more familiar than any other procedures used in the treatment of the orbital blow-out fractures, and the lateral window re-adaptation with an enlarged physiologic ostium differs from the Caldwell–Luc procedure.
REFERENCES 1. Jones D, Evans J. ‘‘Blow-out’’ fractures of the orbit: an investigation into their anatomical basis. J Laryngol Otol 1967;81:1109–1120 2. Smith B. Blowout fracture of the orbit Mechanism and correction of internal orbital fracture. Am J Ophthalmol 1957;44:733–739 3. Soejima K, Shimoda K, Kashimura T, et al. Endoscopic transmaxillary repair of orbital floor fractures: A minimally invasive treatment. J Plast Surg Hand Surg 2013;47:368–373 4. Ridgway EB, Chen C, Colakoglu S, et al. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and metaanalysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 2009;124:1578–1586 5. Walter WL. Early surgical repair of blowout fracture of the orbital floor by using the transantral approach. South Med J 1972;65:1229– 1243 6. Saunders CJ, Whetzel TP, Stokes RB, et al. Transantral endoscopic orbital floor exploration: a cadaver and clinical study. Plast Reconstr Surg 1997;100:575–581 7. Chen C-T, Chen Y-R. Endoscopically assisted repair of orbital floor fractures. Plast Reconstr Surg 2001;108:2011–2018 8. Mohammad J, Warnke P, Shenaq S. Endoscopic exploration of the orbital floor: a technique for transantral grafting of floor blowout fractures. J Craniomaxillofac Trauma 1997;4:16–19 9. Chen JM, Zingg M, Laedrach K, et al. Early surgical intervention for orbital floor fractures: a clinical evaluation of lyophilized dura and cartilage reconstruction. J Oral Maxillofac Surg 1992;50:935–941 10. Matsuo K, Hirose T, Furuta S, et al. Semiquantitative correction of posttraumatic enophthalmos with sliced cartilage grafts. Plast Reconstr Surg 1989;83:429–437 11. Morrison AD, Sanderson RC, Moos KF. The use of silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years. J Oral Maxillofac Surg 1995;53:412–417 12. Sugar A, Kurlakose M, Walshaw N. Titanium mesh in orbital wall reconstruction. Int J Oral Maxillofac Surgery 1992;21:140–144 13. Hwang K, Kita Y. Alloplastic template fixation of blow-out fracture. J Craniofac Surg 2002;13:510–512 14. Persons BL, Wong GB. Transantral endoscopic orbital floor repair using resorbable plate. J Craniofac Surg 2002;13:483–488
e307
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
presence of a prosthetic valve in the brain because of a previous hydrocephalus episode (Figs. 1 and 2). Volumetric increase and vascular alterations in jugal mucosa, buccal vestibule, oral floor, and gingival hyperplasia with discreet vascular hyperplasia were also observed. Those clinical manifestations are in accordance with other studies.6,9 The dental treatment of those patients includes a complete anamnesis considering the principal complaint, the history of actual disease, medical history, systems reviewing, medications intake, and the investigation of previous bleeding in the region of the lesion(s).6 Additionally, intraoral and extraoral examinations evaluating the treatments required (restorative, surgical, periodontal, endodontic, and other treatments) associated with image examinations (computed tomography scan, periapical, and panoramic radiographies) are essential for SWS diagnosis and treatment planning.6 Also, the hemostasis of patients with SWS can be a significant problem when a surgery is planned. To the authors’ best knowledge, there are few studies reporting the risk of bleeding in patients with required endodontic treatments. Some authors reported a case report of a patient with PWS and an endodontically affected central incisor (tooth 21).6 These authors conducted a conventional endodontic treatment with satisfactory clinical outcomes, showing that the endodontic treatment is a feasible alternative in comparison to dental exodontias, because the surgery in these patients requires hospitalization and a multidisciplinary team prepared for their treatment.10
CONCLUSIONS Within the limitations of the present case report, it might be concluded that clinicians must be attentive to the presence of vascular malformations in the head and neck region and also have the expertise to perform emergency treatments in patients with those conditions. The endodontic treatment in patients with SWS is feasible and safe, and it might be an alternative to surgical treatments because patients may experience hemorrhages or undergo treatments that require multidisciplinary care and hospitalization.
REFERENCES 1. Comi AM. Presentation, diagnosis, pathophysiology, and treatment of the neurological features of Sturge-Weber syndrome. Neurologist 2011;17:179 2. Neville BW, Damm DD, Allen CM, et al. Tumors of soft tissues: Oral and maxillofacial pathology. Rio de Janeiro: Guanabara Koogan 2004 3. Alkonyi B, Chugani HT, Karia S, et al. Clinical outcomes in bilateral Sturge-Weber syndrome. Pediatr Neurol 2011;44:443 4. Piram M, Lorette G, Sirinelli D, et al. Sturge-Weber syndrome in patients with facial port-wine stain. Pediatr Dermatol 2012;29:32 5. Gontijo B, Pereira LB, Silva CMR. Malformac¸o˜es vasculares. An Bras Dermatol 2004;79:7 6. Suprabha BS, Baliga M. Total oral rehabilitation in patient with portwine stains. J Indian Pedod Prev Dent 2005;23:99 7. Caiazzo A, Mehra P, Papageorge MB. The use of preoperative percutaneous transcatheter vascular occlusive therapy in the management of Sturge-Weber syndrome: report of a case. J Oral Maxillofac Surg 1998;56:775 8. Zhou Q, Yang XJ, Zheng JW, et al. Hemangioma concurrent with arteriovenous malformation in oral and maxillofacial region: report of a case and review of the literature. J Oral Maxillofac Surg 2011;69:1100 9. De Benedittis M, Petruzzi M, Pastore L, et al. YAG laser for gingivectomy in Sturge-Weber syndrome. J Oral Maxillofac Surg 2007;65:314 10. Montegomery S. Endodontic treatment involving intraoral nevus flammeus. J Endod 1979;5:63
e306
Volume 26, Number 4, June 2015
Simple Repair of a Blow-Out Fracture by the Modified Caldwell–Luc Approach Min Woo Park, DDS, MSD, Soung Min Kim, DDS, MSD, Emmanuel Kofi Amponsah, DDS, PhD,y and Suk Keun Lee, DDS, MSDz Abstract: Here we report a patient with a blow-out fracture of the orbital floor that was treated by an intraoral transmaxillary approach. This 38-year-old man suffered a sudden blow to the periorbital area, which caused prolapse of the orbital contents into the maxillary sinus. The modified Caldwell–Luc approach was used to repair the orbital blow-out fracture and the maxillary sinus during was packed with Frazin gauze for 7 days to prevent recurrence of the prolapse. This was an easy and minimally invasive technique for the management of a blow-out fracture of the orbital floor. Key Words: Blow-out fracture, modified Caldwell–Luc approach
INTRODUCTION
O
rbital floor blow-out fractures often result in prolapse of the orbital contents into the maxillary sinus.1 Although the first report of a blow-out fracture was in 1957,2 controversy remains regarding methods for surgical treatment, including the best approach to the orbit. Traditionally, a transorbital approach to the orbital floor via various lower eyelid incisions has been used in the field of plastic surgery.3 However, subciliary and transconjunctival approaches have high incidences of cosmetic complications.4 A transmaxillary approach to the orbital floor was first reported in the 1972 by Walter5 and became well-established, thanks to advances in endoscopic sinus surgery.6 However, controversy remains concerning the method for support of the orbital floor after elevation of the orbital contents. At the time of this report we use Frazin gauze packing to support the orbital floor for 7 days; this technique is simple and minimally invasive.
CASE REPORT A 38-year-old man fell and hit his face on the floor and visited the department of oral and maxillofacial surgery with ecchymosis of the From the Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea; yDepartment of Oral and Maxillofacial Surgery, Brong Ahafo Regional Hospital, Sunyani, Ghana; and zDepartment of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. Received December 18, 2014. Accepted for publication January 29, 2015. Address correspondence and reprint requests to Dr Soung Min Kim, DDS, MSD, Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 110-768, Korea; E-mail: [email protected] This research was supported by the International Research & Development Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Plannig (Grant number: 2014K1A3A9A01033785) The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001698 #
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
Volume 26, Number 4, June 2015
FIGURE 1. The coronal computed tomographic view, preoperative depressed orbital floor with hematoma and sinusitis (A), postoperative 2 years’ view (B).
left periorbital area and diplopia on upward gaze. On examination, upward gaze was limited on the left side, and he had decreased sensation of his left infraorbital area. Water’s view and computed tomography revealed a blow-out fracture with depression of the orbital floor. The orbital rim was intact (Fig. 1A). On the 3rd day after trauma, an operation was performed under general anesthesia. A round shaped bony window of 1 cm diameter was made in the anterior wall of the maxillary sinus using a small round bur. The bony window was secured with a titanium miniplate and 3 miniscrews and removed to be kept separately (Fig. 2). The orbital floor, exposed orbital contents, maxillary sinus ostium, and infraorbital nerve were inspected with a sinus endoscope through both this hole and the nasal cavity (Fig. 3). Although gentle pressure was applied to the herniated orbital soft tissue using a cotton ball held in place with a small mosquito clamp and sinus forceps, forced duction testing was performed to confirm proper reduction. The maxillary ostium was enlarged by an endonasal approach with a sinus endoscope. Then longitudinally folded Frazin gauze was packed into the maxillary sinus and 1 side of the gauze was pulled into the nasal cavity through the enlarged maxillary ostium. The bony window was placed in the original position and fixed with a miniplate and screws (Fig. 2). The patient was instructed to elevate his head at all times and maintain the orthostatic position. Eight days after the operation, the Frazin gauze was removed via the maxillary ostium on an outpatient basis. Postoperative Water’s radiographs were taken at 1 day, 2 weeks, and 6 weeks after the operation to check for recurrent prolapse of the orbital contents, and the patient was followed for 2 years. The enophthalmos and diplopia were corrected and postoperative computed tomography and radiographs revealed the reconstructed orbital floor to be in the proper position throughout the follow-up period without maxillary sinusitis over the 2 years of follow-up (Fig. 1B).
DISCUSSION A blow-out fracture is a downwardly displaced fracture of the orbital rim or floor resulting in increased orbital volume due to the blunt ocular trauma. A routine transorbital approach to the orbital floor via several lower eyelid incisions has been applied; however,
FIGURE 2. Intraoperative photograph showing the repositioned anterolateral wall of the maxillary sinus fixed with microplate and 3 screws.
FIGURE 3. Schematic drawing of endoscopic assisted modified Caldwell–Luc procedure used in this case report.
#
2015 Mutaz B. Habal, MD
Brief Clinical Studies
it has many limitations such as optic nerve damage during exploration of the posterior aspect, cosmetic problems, and conjunctival damage.3 On the contrary, the transmaxillary Caldwell–Luc approach has some advantages such as good visualization, precise confirmation of a blow-out fracture, easy management of entrapped periorbital tissue, and no visible scarring.7 We made the window on the anterolateral wall of the maxillary sinus as in the Caldwell–Luc procedure. The lateral window was made with a very small round bur and was repositioned with titanium miniplate fixation to avoid postoperative scarring and postoperative maxillary cysts. Enlargement of the patient’s own osteomeatal unit using a nasal endoscope instead of an inferior osteotomy as in the Caldwell–Luc procedure has excellent results in terms of physiologic sinus function. There are many substitutive implant materials used to support the orbital floor after elevation of the orbital contents. Autogenous bone,8 lyophilized cartilage or dura,9 sliced costal cartilage,10 silastic sheets,11 titanium mesh,12 MEDPOR,13 or resorbable Plate14 are all been used. In this modified Caldwell-Luc procedure, we used Frazin gauze to support the orbital floor and keep it in the maxillary sinus over the course of 8 days. There were no complications in this patient, complete resolution of the preoperative diplopia was achieved, and no late-developing enophthalmos was seen. This endoscopic-assisted modified technique is easy and more familiar than any other procedures used in the treatment of the orbital blow-out fractures, and the lateral window re-adaptation with an enlarged physiologic ostium differs from the Caldwell–Luc procedure.
REFERENCES 1. Jones D, Evans J. ‘‘Blow-out’’ fractures of the orbit: an investigation into their anatomical basis. J Laryngol Otol 1967;81:1109–1120 2. Smith B. Blowout fracture of the orbit Mechanism and correction of internal orbital fracture. Am J Ophthalmol 1957;44:733–739 3. Soejima K, Shimoda K, Kashimura T, et al. Endoscopic transmaxillary repair of orbital floor fractures: A minimally invasive treatment. J Plast Surg Hand Surg 2013;47:368–373 4. Ridgway EB, Chen C, Colakoglu S, et al. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and metaanalysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 2009;124:1578–1586 5. Walter WL. Early surgical repair of blowout fracture of the orbital floor by using the transantral approach. South Med J 1972;65:1229– 1243 6. Saunders CJ, Whetzel TP, Stokes RB, et al. Transantral endoscopic orbital floor exploration: a cadaver and clinical study. Plast Reconstr Surg 1997;100:575–581 7. Chen C-T, Chen Y-R. Endoscopically assisted repair of orbital floor fractures. Plast Reconstr Surg 2001;108:2011–2018 8. Mohammad J, Warnke P, Shenaq S. Endoscopic exploration of the orbital floor: a technique for transantral grafting of floor blowout fractures. J Craniomaxillofac Trauma 1997;4:16–19 9. Chen JM, Zingg M, Laedrach K, et al. Early surgical intervention for orbital floor fractures: a clinical evaluation of lyophilized dura and cartilage reconstruction. J Oral Maxillofac Surg 1992;50:935–941 10. Matsuo K, Hirose T, Furuta S, et al. Semiquantitative correction of posttraumatic enophthalmos with sliced cartilage grafts. Plast Reconstr Surg 1989;83:429–437 11. Morrison AD, Sanderson RC, Moos KF. The use of silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years. J Oral Maxillofac Surg 1995;53:412–417 12. Sugar A, Kurlakose M, Walshaw N. Titanium mesh in orbital wall reconstruction. Int J Oral Maxillofac Surgery 1992;21:140–144 13. Hwang K, Kita Y. Alloplastic template fixation of blow-out fracture. J Craniofac Surg 2002;13:510–512 14. Persons BL, Wong GB. Transantral endoscopic orbital floor repair using resorbable plate. J Craniofac Surg 2002;13:483–488
e307
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
