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The Superficial Temporoparietal Adipo-fascial Flap: A Novel Approach for Increasing Orbital Volume in Enophthalmus
William Abouhassan MD(1,2)
Gaby Doumit MD MSc(2,3)
Michael J Yaremchuk MD(3)
(1)Division of Plastic, Reconstructive & Hand/Burn Surgery, Department of Surgery, University of Cincinnati College of
Division of Plastic, Reconstructive & Hand/Burn Surgery, Department of Surgery, University of Cincin
2012-02-15
Presenter: William Abouhassan, MD
Affidavit:
The entirety of the above work represents the original work of the resident during scholarly activity while training in plastic surgery.
Director Name: W. John Kitzmiller, MD
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
1. Conference participants will be able to demonstrate knowledge of current concepts in augmentation of the craniofacial skeleton, particularly addressing symptomatic enophthalmus deformities and correction.
2. Participants will be able to assess data on managing patient complications and recurrence of enophthalmus following alloplastic implantation of the orbits, and how to improve the care of patients with recurrence by considering autologous tissue implantation.
3. Participants will address clinical science research, techniques, and procedures relevant to craniofacial soft tissue and skeletal augmentation with both alloplastic and autologous material.
How will your presentation be used by practicing physicians in the audience?
1. Practicing physicians will review the symptoms of enophthalmus and surgical options available to the patient, in particular augmentation of the craniofacial skeleton addressing symptomatic enophthalmus deformities and correction.
2. Practicing physicians review a case of recurrence of enophthalmus and how to successfully manage complications and recurrence following alloplastic implantation of the orbits.
3. Practicing physicians will be introduced to a novel flap design and the technique used to augment the orbits with autologous material after failure of alloplastic implantation in enophthalmus.
Background: Enophthalmos is imbalance of orbital volume and content causing posterior displacement of the globe leading to orbital asymmetry, deep superior sulcus, pseudoptosis, lagophthalmos, diplopia or dry eyes. We present a case of bilateral enophthalmus that underwent surgical correction with alloplastic implants eight years prior. He re-presents with recurrence of enophthalmus, lack of lower eyelid contact to the globes, trichiasis, and purulent drainage. A novel approach utilized bilateral superficial temporoparietal adipo-fascial flaps (STAF) (superficial temporal artery axial flaps) raised and rotated into orbits, increasing volume and globe projection.
Methods: Superficial temporal arteries were identified. Bilateral 2.5cm x 12cm axial flaps were raised supra-periosteally to the zygomatic arch, incorporating skin, galea, and superficial temporoparietal fascia. Through transconjuctival with lateral canthotomy incisions the lateral orbital walls were burred and openings created. Flaps were deepithelialized, rotated, and tunneled through the orbitotomies. STAFs were positioned posterior to globes. We followed postoperatively.
Results: Follow-up occurred at one, three, six and twenty-six weeks. Blurry vision and purulent drainage resolved. Ocular exams displayed resolution of trichiasis, demonstrating full contact of lower eyelids to globes. There was no postoperative wound infection, breakdown, or hematoma.
Conclusion: Alloplastic material augmenting the craniofacial skeleton may make significant improvements for patients with various conditions. Successfully augmenting the orbit has been reported. Autologous tissue must be considered in treating recurrence. The first description of the STAF and its success in increasing orbital volume and globe projection is demonstrated for two eyes. This is safe, reliable, and relatively easy to execute without significant complications.
