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1 안와골절복원술후의복시와안구함몰 : 안와골절시발생하는복시와안구함몰은수술후에도호전되지않는경우가많아기능및미용상문제를유발하기도한다. 저자들은안와골절환자에서안와골절복원술후복시와안구함몰의발생과관련된여러인자를분석하고, 이러한인자와관련된수술결과를알아보았다. : 1995년 3월부터 2002년 6월까지안와골절로안와골절복원술을시행한 50안을대상으로환자의나이, 골절의크기, 수술시기, 골절의위치, 수술전후복시와안구함몰의빈도를후향적으로알아보고, 관계를분석하였다. : 술전 32명에서복시소견을보였으나, 술후 9명에서복시가지속되었다. 술전 16명에서 2 mm 이상의안구함몰이있었으나, 술후 5명에서안구함몰이지속되었다. 조기에수술할수록술후복시와안구함몰의발생이적었으며, 환자의연령과골절크기는잔여복시, 안구함몰의발생에유의한영향을미치지않았다. : 안와골절의수술적교정은복시와안구함몰을호전시키며조기에수술할경우술후잔여복시와안구함몰의발생을줄여준다. 안와골절환자에서다양한변수를고려하여수술을시행한다면기능적, 미용적으로만족스런결과를얻을수있을것으로생각된다. < 한안지 44(9): , 2003> 1959

2 Table 1. Preoperative and postoperative diplopia 18 years old or younger (N=6) 19 years old or old (N=44) operated within 14 days (N=40) operated after 14 days (N=10) small fracture (<25%) (N=11) medium fracture (25-50%) (N=9) large fracture ( 50%) (N=37) Inferior wall fracture (N=18) medial wall fracture (N=10) combined fracture (N=22) Inf. wall * (N=9) Inf. and med. wall (N=13) * Only inferior wall was repaired. Both inferior and medial6 wall were repaired. Preoperative diplopia (N=32) 3/6 (50%) 29/44 (66%) 27/40 (68%) 5/10 (50%) 2/4 (50%) 3/9 (33%) 27/37 (73%) 14/18 (88%) 5/10 (50%) 13/22 (77%) 6/13 (46%) 7/9 (78%) Postoperative diplopia (N=9) 2/6 (33%) 7/44 (15%) 6/40 (15%) 3/10 (30%) 0/4 (0%) 1/9 (11%) 8/37 (21%) 6/18 (33%) 0/10 (0%) 3/22 (13%) 3/13 (23%) 3/9 (33%) 1960

3 Table 2. The characteristics of patients with postoperative diplopia Postoperative diplopia (+) (N=13) Preoperative enophthalmos (+) Postoperative enophthalmos (+) Fracture size ( 50%) Age (19 years old or old) Time interval between trauma and surgery (operated after 14 days) Fracture site (inferior and medial) Preoperative diplopia (+) (N=9) 5 (56%) 3 (33%) 8 (89%) 7 (78%) 3 (33%) 3 (33%) Preoperative diplopia (-) (N=4) 1 (25%) 2 (50%) Table 3. Preoperative and postoperative enophthalmos 18 years old or younger (N=6) 19 years old or old (N=44) operated within 14 days (N=40) operated after 14 days (N=10) small fracture (<25%) (N=4) medium fracture (25-50%) (N=9) large fracture ( 50%) (N=37) Inferior wall fracture (N=18) Medial wall fracture (N=10) Combined wall fracture (N=22) Inf. wall * (N=9) Inf. and med. wall (N=13) * Only inferior wall was repaired. Preoperative enophthalmos (N=16) 2/6 (33%) 14/44 (32%) 11/40 (28%) 5/10 (50%) 0/4 (0%) 4/9 (44%) 12/37 (32%) 3/18 (16%) 1/10 (10%) 12/22 (54%) 7/9 (78%) 5/13 (38%) Postoperative enophthalmos (N=5) 0/6 (0%) 5/44 (11%) 2/40 (5%) 3/10 (30%) 0/4 (0%) 1/9 (11%) 4/37 (10%) 0/18 (0%) 0/10 (0%) 5/22 (22%) 3/9 (33%) 2/13 (15%) Both inferior and medial wall were repaired. 1961

4 Table 4. The characteristics of patients with postoperative enophthalmos Postoperative enophthalmos(+) (N=9) Fracture size ( 50%) Age (19 years old or old) Time interval between trauma and surgery (operated after 14 days) Fracture site (inferior and medial) Preoperative enophthalmos (+) (N=5) 4 (80%) 5 (100%) 3 (60%) 5 (100%) Preoperative enophthalmos (-) (N=4) 0 (0%) 1 (25%) 1962

5 1) Dortzbach RK. Orbital floor fractures. Ophthal Plast Reconstr Surg 1985;1: ) Hosal BM, Beatty RL. Diplopia and enopthalmos after surgical repair of blowout fracture. Orbit 2002;21: ) Putterman AM, Stevens T, Urist MJ. Nonsurgical management of blowout fractures of the orbital floor. Am J Ophthalmol 1974;77: ) Gilbard SM, Mafee MF, Lagouros PA, Langer BG. Orbital blowout fractures. The prognostic significance of computed tomography. Opthalmology 1985;92: ) Pearl RM. Treatment of enopthalmos. Clinics in plastic surgery 1992;19: ) Iliff NT. The opthalmic implications of the correction of late enophthalmos following severe midfacial trauma. Trans Am Opthalmol Soc 1991;89:

6 7) Smith B, Regan WF Jr. Blow-out fracture of the orbit. Mechanism and correction of internal orbital fracture. Am J Opthalmol 1957;44: ),. Medpor Enopthalmos Wedge Implant. 2002;43: ) Putterman AM, Stevens T, Urist MJ. Nonsurgical management of blow-out fractures of the orbital floor. Am J Ophthalmol 1974;77: ) Rubin PA, Bilyk JP, Shore JW. Management of orbital trauma: fractures, hemorrhage, and traumatic optic neuropathy. Am Acad Ophthalmol Focal Points 1994;7: ) Dutton JJ, Manson PN, Iliff N, Putterman AM. Management of blow-out fractures of the orbital floor. Surv Ophthalmol 1990;35: ) Seiff SR, Good WV. Hypertropia and the posterior blowout fracture. Mechanism and management. Ophthalmology 1996; 103: ) Kushner BJ. Paresis and restriction of the inferior rectus muscle after orbital floor fracture. Am J Ophthalmol 1982; 94: ) Biesman BS, Hornblass A, Lisman R, Kazlas M. Diplopia after surgical repair of orbital floor fractures. Opthalmic Plast Reconstr Surg 1996;12: ) Emory JN, Von Noorden GK, Schlernitzauer DA. Management of orbital floor fractures. Am J Ophthalmol 1972;74: ) Greenward HS Jr, Keeney AH, Shannon GM. A review of 128 patients with orbital fractures. Am J Opthalmol 1974;78: ) Emory JN, Von Noorden GK, Schlernitzauer DA. Orbital floor fractures: Long-term follow-up of cases with and without surgical repair. Trans Am Acad Ophthalmol Otolaryngol 1971; 75: ) Leitch RJ, Burke JP, Strachen IM. Orbital blowout fractures - the influence of age on surgical outcome. Acta Opthalmol 1990;68: ),, ;38: ) Smith B, Lisman RD, Simontan J. Volkman's contracture of the extraocular muscles following blow-out fracture. Plast Reconstr Surg 1984;74: ) Dortzbach RK, Kikkava DO. Blowout fractures of the orbital floor. American Academy of Ophthalmology 1995; ) Converse JM, Smith B, Obear M, Smith WD. Orbital blowout fractures : A ten year survey. Plast Reconstr Surg 1967;39: ) Burres SA, Cohn AM, Mathog RH. Repair of orbital blowout fractures with Marles mesh and Gelfilm. Laryngoscope 1981;91: ), ;42: ) Grant MP, Iliff NT, Manson PN. Strategies for treatment of enophthalmos. Clin Plast Surg 1997;24; ) Lonaker MT, Kawamoto HK. Evolving thoughts on correcting posttraumatic enophthalmos. Plast Reconstr Surg 1998;101:

7 Residual Diplopia and Enophthalmos after Reconstruction of Orbital Wall Fractures Jung Hyuk Hwang, M.D., Mi Seon Kwak, M.D. Department of Ophthalmology, Daegu Fatima Hospital Purpose: We evaluated the risk factors and related results of residual diplopia and enophthalmos in patients who had orbital wall fracture repair. Methods: 50 patients with orbital wall fracture who were followed up for at least 6 months postoperatively were included in this study. We analyzed effects of the patient age, timing of surgery, size and location of fracture on development of postoperative diplopia and enophthalmos. Results: 32 patients had diplopia and 16 patients had enophthalmos greater than 2 mm. Among 32 patients with preoperative diplopia, 9 patients experienced postoperative diplopia. Among 16 patients with preoperative enophthalmos, 5 patients experienced postoperative enophthalmos. Delayed timing of surgery was a significant factor for development of postoperative diplopia and enophthalmos. Age of the patients and fracture size were not significant factors for development of postoperative diplopia and enophthalmos. Conclusions: Early surgical repair of orbital wall fractures decreases the incidence of residual diplopia and enophthalmos. Preoperative assessment of multiple variables could help to achieve cosmetical and functional better results. J Korean Ophthalmol Soc 44(9): , 2003 Key Words: Blowout fractures, Diplopia, Enophthalmos 1965

노영남

노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding