En bloc resection of the lateral orbital rim to reduce exophthalmos in patients with Graves' disease.
BACKGROUND
Today, elective surgical procedures are performed on patients with thyroid-associated orbitopathy for aesthetic and "quality-of-life" reasons and only rarely in emergency cases to prevent blindness. The surgical methods should have minimal adverse effects and reliable outcomes.


METHODS
En bloc resection of the lateral orbital rim and part of the orbital floor was performed on 44 patients over a 7-year period. An osteotomy was made in the inferolateral wall of the orbit via a subciliary incision and the periorbital tissues were resected. Exophthalmos reduction, postoperative changes in strabismus and extraocular muscle function, visual acuity and follow-on operations were analysed.


RESULTS
Most patients underwent surgery for exophthalmos, conjunctival and corneal symptoms. The average exophthalmos reduction was 3.8+/-1.5mm (range 1.5-7.5mm, p<0.01). No loss of vision was noted. Overall, a reduction in diplopia was achieved, although new strabismus appeared after surgery in one patient. Nineteen patients required additional lid surgery.


CONCLUSIONS
The procedure for exophthalmos reduction is as effective as other two-wall expansion methods and it features low risks for loss of vision, new-onset diplopia and other disturbances of extraocular motility.
Schaaf
Heidrun
H
Department of Maxillofacial Surgery (Chairperson: Dr. Dr. Hans-Peter Howaldt, Professor), University of Giessen, Germany. heidrun.schaaf@uniklinikum-giessen.de <heidrun.schaaf@uniklinikum-giessen.de>
Santo
Gregor
G
Gräf
Michael
M
Howaldt
Hans-Peter
HP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004172:Diplopia / Q000209:etiology / Q000601:surgery; D005094:Exophthalmos / Q000209:etiology / Q000601:surgery*; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013285:Strabismus / Q000209:etiology / Q000601:surgery; D014792:Visual Acuity; D055815:Young Adult