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KMID : 0602919960020010013
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Journal of the Korean Society of Aesthetic Plastic Surgery
1996 Volume.2 No. 1 p.13 ~ p.23
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Correction of Exophthalmos in Orientals and Longterm Follow-UP
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Abstract
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Orbital decompression in exophthalmos has been tried for more than 100 years but there was no definite procedure falling to achieve the desired result, and yet these operations have not gained broad acceptance.
Basic principles in orbital decombression were the concept of the axis of the eyeball, procedure without change of visual axis as possible and the preservation of continuity of paranasal sinus mucosa. The axis of the globe extends from the
lateral
orbital wall to the lamina papyracea and the position of the globe was affected by the volume change behind the global axis. Unidirectionnal orbital decompression changes the visual axis and the patient suffers from the diplopia. Discontinuity of
paranasal sinus mucosa has chances of postoperative infection or extraocular muscle dysfunction.
So we corrected exophthalmos as follows:
Blow out fracture of the medial wall and orbital floor was done with blunt osteotome without tearing of maxillary and ethmoid sinus mucosa.
Lateral wall halving osteotomy land valgus pivoting of the posterior portion of the lateral orbital wall were done without increase in the bitemporal or bimalar width.
The orbital fat was removed behind the global axis mainly in upper half of the orbit, which could take effect of the orbital roof decompression.
The combination of each method enabled to decompress in all direction and preserve the original visual axis. Total reducing effects of exophthalmos by operation were resulted from the expanded capacity of the bony orbit and the removed amount of
orbital
soft tissues. We evaluated the result with exophthalmometer, global axis to cornea distance and orbital volume before and after operation
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