Journal of Clinical & Experimental Dermatology Research
Open Access
ISSN: 2155-9554
+44 1478 350008
ISSN: 2155-9554
+44 1478 350008
Young Joon Jun, Jung Ho Lee, Yoon-Jae Lee, Suk-Ho Moon and Young Jin Kim
Posters-Accepted Abstracts: J Clin Exp Dermatol Res
Purpose: An orbital blowout fracture is a commonly occurring facial trauma disorder that accounts for 7.6% of isolated facial fractures, and post-operative complications include diplopia, enophthalmos, hypoesthesia and optic neuropathy. Among these complications, optic neuropathy is a potential blinding complication of an orbital blow out fracture. The most common form oftraumatic optic neuropathy is an indirect injury to the optic nerve due to intraorbital hemorrhage, vascular insufficiency ora nerve sheath injury whereas direct damage to the optic nerve during dissection and insertion of implant materials is also possible. We report a case of a patient with post-operative traumatic optic neuropathy due to indirect nerve damage after traction forced was applied to release a severe adhesion during a dissection procedure. Method: A 35-year-old female patient was referred from the ophthalmology department complaining of right eye enophthalmos and presented for surgical correction of a right-sided upward gaze limitation (Fig. 1A & B). Visual acuity was within the normal range on the right 0.9 and left sides 0.7. Computed tomography (CT) images of facial area, showed a focal bony dehiscence accompanying the inferior rectus muscle and fat entrapped in the medial aspect of the inferior wall of the right orbit (Fig. 2). An orbital tissue hernia including the inferior rectus muscle within the bone defect was released, and the orbital floor was reconstructed using a 2.0 Ã?3.0 cm synthetic resorbable implant. Careful dissection was difficult because of the severe adhesion surrounding the inferior rectus muscle. Result: On post-operative day 2, a physical examination, revealed that vertical eye movement remained restricted and that there was a superior visual defect with decreased visual acuity from 0.9 to 0.15. No evidence of optic nerve compression was detected on the immediate postoperative CT images but demonstrated improvement in the right inferior rectus muscle entrapment was observed (Fig. 3A). The patient was treated with intravenous and oral corticosteroid and the synthetic resorbable implant was removed under local anesthesia on day 2 after the operation. Mild fibrosis and thickening around the inferior rectus muscle was confirmed on magnetic resonance imaging 3 weeks after surgery without optic nerve injury (Fig. 3B).