title: Secondary Orbital Reconstruction in Patients with Prior Orbital Fracture Repair.
abstract: OBJECTIVE
  To evaluate clinical characteristics, preoperative imaging findings, pre- and post-operative outcomes, and satisfaction of patients requiring secondary reconstruction after inadequate primary orbital fracture repair.
  
  
  METHODS
  Retrospective review of 13 patients requiring secondary orbital reconstruction following unsatisfactory primary repair. Primary outcomes were postoperative changes in enophthalmos, hypo- or hyper-globus, superior sulcus deformity, and restrictive strabismus. Secondary outcomes included patient satisfaction.
  
  
  RESULTS
  Of 13 patients, 9 patients had primary orbital implants, and 4 patients did not. Of the 9 with implants, 6 had inferior displacement posteriorly, 2 had superior displacement posteriorly, and 1 had good position but had entrapped orbital tissues beneath it. Findings from primary surgery included enophthalmos (12/13), hypoglobus (10/13), hyperglobus (1/13), superior sulcus deformity (9/13), restricted supraduction (12/13), and restricted infraduction (7/13). Mean preoperative enophthalmos and hypoglobus were 4.4 ± 2.6 mm and 2.9 ± 1.4 mm, respectively. Secondary reconstruction resulted in mean reduction of enophthalmos by 3.4 ± 1.4 mm (p < 0.001), of hypoglobus by 2.9 ± 1.5 mm (p < 0.001), and of hyperglobus by 1 mm (n = 1). All 9 patients had resolution of their superior sulcus deformity. Of 12 cases with restricted ocular motility, all had improvements in postoperative motility following secondary surgery. Mean improvement in supraduction and infraduction was 1.8 ± 1.0 points (p < 0.001) and 1.4 ± 1.3 points (p = 0.025), respectively. Twelve patients reported being very satisfied or satisfied with secondary surgery; 1 patient was neutral.
  
  
  CONCLUSIONS
  This study demonstrates that secondary orbital reconstruction can achieve excellent functional and cosmetic results with high patient satisfaction and minimal complications. Secondary reconstruction of previously repaired orbital fractures should be considered when clinically indicated.
authors.affiliation: Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California, U.S.A.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Kim
authors.forename: Bradford W
authors.initials: BW
authors.lastname: Lee
authors.forename: Richard L
authors.initials: RL
authors.lastname: Scawn
authors.forename: Bobby S
authors.initials: BS
authors.lastname: Korn
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015841:Enophthalmos / Q000209:etiology / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000175:diagnosis / Q000601:surgery*; D020273:Orbital Implants; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult