OPRS Images

Severely Decreased Ocular Motility and Dystopia Secondary to Repeated Orbital Volume Augmentation Craig N. Czyz, D.O., F.A.C.O.S.*†, Elda L. Fisher, D.M.D., M.D.‡, Kevin Kalwerisky, M.D.,† and Jill A. Foster, M.D., F.A.C.S.*† *Division of Ophthalmology, Section Oculofacial Plastic Surgery, OhioHealth/Ohio University, Columbus, OH, U.S.A.; †Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, U.S.A.; and ‡Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, NC, U.S.A. (E-mail: [email protected])

FIG. 2.  Explanted orbital material.

FIG. 1.  Coronal and sagittal orbital CT images.

A

25-year-old man sustained multiple facial fractures from a motor vehicle accident. An initial left orbital reconstruction involving the floor, roof, lateral wall, and orbital rims was performed by general plastic surgery. The superior, lateral, and inferior orbital rims were repaired with titanium plates. The orbital Accepted for publication July 26, 2014. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Craig N. Czyz, D.O., F.A.C.O.S., 262 Neil Ave., Suite 430, Columbus, OH 43215. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000294

e48

floor was repaired with a Medpor orbital floor implant (Stryker, Kalamazoo, MI, U.S.A.). At the time of this initial surgery, additional orbital floor implants were placed behind the equator of the globe to address enophthalmos. Six weeks after the initial operation, the patient underwent revision surgery to address residual enophthalmos with placement of multiple cut fragments of SynPOR implants (Synthes, Inc., West Chester, PA, U.S.A.). The patient was subsequently referred to the oculoplastic clinic for evaluation of globally restricted motility. A CT was obtained that showed multiple stacked implants in various positions in the orbit (Fig. 1A,B). As seen in the sagittal view, there were several implants placed behind the globe with some in close proximity to the optic nerve. The patient returned to the operating room where all implants were removed from the left orbit. A total of 13 implants were removed from the left orbit with 8 fragments as shown in Figure 2. A revised Medpor Titan orbital floor implant was then placed to anatomically bridge the fracture site, which resulted in postoperative correction of enophthalmos, globe dystopia, and improvement of ocular motility. Ophthal Plast Reconstr Surg, Vol. 31, No. 2, 2015

Severely decreased ocular motility and dystopia secondary to repeated orbital volume augmentation.

Severely decreased ocular motility and dystopia secondary to repeated orbital volume augmentation. - PDF Download Free
355KB Sizes 3 Downloads 8 Views