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Purpose Surgery in endocrine orbitopathy should address exophthalmos and adjunct stigmata such as increased lid aperture and scleral show. Secondary to decompression, rehabilitative surgical treatment such as blepharoplasty is routinely used to achieve this goal. Until now, however, there has been no investigation to measure the effect of decompression surgery on scleral show and lid aperture 3-dimensionally. Materials and methods Ocular surface area (OSA) and lid aperture of 34 patients (67 orbits) were measured pre and post decompression surgery in a retrospective investigation using 3-dimensional (3D) stereophotogrammetry. The mean follow-up after decompression was 6 ± 4 months. Results Mean OSA ranged between 3.1 ± 1.5 cm2 (pre orbital decompression) and 2.5 ± 0.6 cm2 (post orbital decompression). Orbital decompression caused a statistically significant reduction of the surface area of about 19.4% (p Conclusion Our results show that surgical decompression, besides correcting exophthalmos, leads to a significant reduction of scleral show and lid aperture. However, it is not possible to estimate its effect on an individual basis.

The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction. We included nine patients (six males, three females; mean age 51; range 20–73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound. After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm). Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.

Background Surgical treatment of endocrine orbitopathy can be performed by way of resecting orbital walls, which effectively releases superfluous tissue from the surgically enlarged orbital space allowing the eyeballs to move back. Existing approaches aim to select an optimal surgical strategy based on statistical correlations between the extent of the surgical procedure and the resulting bulbus displacement but do not provide an individual surgery plan or predict surgery outcome. Methods In this retrospective study, we performed a quantitative analysis of pre- and post-surgery 3D tomographic data of six patients and applied explorative biomechanical modeling of orbital mechanics to dissect factors influencing patient-specific outcome. Findings Our experimental results showed a large variability of the backward eyeball displacement in dependency on the amount of orbital volume flow, which could partially be described by computational simulation. Our detailed analysis revealed that patients with regular fat tissue show a good correlation between bulbus displacement and relative volume of decompressed tissue, which, in turn, correlates with decrease in hydrostatic pressure. In contrast, patients with fibrotic tissue exhibit significantly reduced and computationally less predictable eyeball translation in response to surgical tissue decompression. Interpretation Based on the results of this study we see a great potential for quantitative planning of surgical exophthalmos treatment using 3D biomechanical modeling. Conventional approaches to planning of soft tissue interventions consider, however, only the patient's 3D anatomy and widely disregard individual tissue properties. Further investigations are required to establish reliable procedures for assessment of individual tissue properties and incorporating them into patient-specific models of orbital mechanics.

ZusammenfassungFrakturen des Gesichtsschädels sind im Kindesalter relativ selten, Jungen sind dabei häufiger betroffen als Mädchen. Nasengerüstfrakturen stellen die häufigste Gruppe dar, gefolgt von Unterkiefer- und lateralen Mittelgesichtsfrakturen. Mit zunehmendem Alter steigt das Frakturrisiko, und das Ursa-chenspektrum verändert sich hierbei von Stürzen und Verkehrsunfällen hin zu Sportunfällen und Rohheitsdelikten. Mit dem Teen-ageralter verschiebt sich die Behandlung von eher konservativer zur operativen Behand-lung durch offene Reposition und interne Fixation. Eine Ausnahme bilden Orbitawandfrakturen, die bei einer Einklemmung von Orbitainhalt in jedem Kindesalter unverzüglich operiert werden müssen, um dauerhafte funktionelle Spätschäden zu verhindern. Weitere potenzielle Spätschäden betreffen vor allem das Wachstum von Nase und Unterkiefer und bedürfen einer operativen Korrektur nach Wachstumsabschluss. Hinsichtlich der bildgebenden Diagnostik ist die klassische Projektionsradiografie meist wenig aussagekräftig, sodass in begründeten Fällen eine dosisangepasste CT-Diagnostik das Mittel der Wahl darstellt.

Purpose In navigated craniomaxillofacial surgery, bone segments often have to be repositioned. To keep them reliably in the desired place during referencing and osteosynthesis, a miniature external distractor can be used. Materials and methods The use of a miniature external mandibular distractor is shown in a case of bilateral lateral orbital rim advancement during endocrine orbitopathy decompression surgery. Results The advantages of using a distractor are the possibility of changing the fragment position incrementally in all directions during intraoperative control with the navigated pointer and the small size of the appliance. Conclusions Bone segments can be manipulated intraoperatively with a miniature distractor in navigated surgery.

Purpose Orbital wall decompression is routinely used to treat proptosis in endocrine orbitopathy. Until now, however, there has been no investigation to measure the area/extent of the removed walls. Materials and methods The inner areas of 154 orbital walls (lateral, inferior, medial) which had been resected in 38 patients were measured using pre- and postsurgical computed tomographic data in Brainlab iPlan software. Furthermore the effect of concomitant centrolateral orbital rim advancement was calculated in 48 cases. Surgery was performed after preoperative planning using intraoperative navigation. Results The mean area of resected inferior and medial orbital walls lay at 6.7 cm 2 and 6.2 cm 2 , while the area of the lateral orbital wall was 6.9 cm 2 . Rotation-advancement of the lateral rim added an area of 1.8 cm 2 (∼25% of the lateral orbital wall). Comparison of the pre- and postsurgical computed tomographic data showed excellent conformity of the presurgical planning and postsurgical results. Conclusions This investigation is a first step in analyzing the potential surgical effect of bony decompression surgery by stating the metric amount of orbital wall removal. Using these data, further studies will be performed in the future.

Die Distraktionsosteogenese des Oberkiefers stellt eine anerkannte Methode in der Behandlung ausgepragter Oberkieferrucklagen dar. Haupteinsatzgebiete sind Verlagerungen uber 10 mm bzw. vernarbte Weichgewebssituationen. Im Vergleich intra- und extraoraler Distraktoren erscheinen halobogen-verankerte externe Systeme vielfaltiger einsetzbar zu sein. Hierbei zeigen knochenverankerte Systeme geringere dentale Nebenwirkungen als zahngetragene. Wahrend die Stabilitat der Oberkieferposition der konventioneller Verfahren entspricht, ist die Komplikationsrate aufgrund der anspruchsvollen Technik hoher.

Between June 1996 and November 2000 60 patients suffering from severe nasal dysplasia due to cleft lip and palate (CLP) underwent corrective nasal surgery. Diagnoses included 37 cases of unilateral CLP and 23 cases of bilateral CLP. Age ranged from 7 to 50 years. To assess functional outcome three different methods were used pre- and postoperatively with and without nasal decongestion: active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry. For the measurement of esthetic changes frontal, lateral, and caudal photographs were analyzed. Compared to a non-cleft population esthetic and functional impairment was evident preoperatively. Postoperatively a statistically significant improvement in nasal projection and configuration was seen. Concerning nasal respiration an improvement in nasal flow and hydraulic diameter was noted in the unilateral CLP group only, whereas a statistically nonsignificant average deterioration was found in the bilateral CLP group. No correlation existed between external nasal form or the change in nasal appearance and nasal function. Whereas the esthetic outcome of nasal surgery is covered by way of photo-analysis in many centers, a distinct lack of measuring the effects on nasal function can be stated. Without using objective methods, however, no data for improving surgical procedures and for internal quality control are at hand.

Summary A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.