Plastic Surgery Research Council

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Graded Balanced Orbital Decompression With Stereotactic Navigation
Connor Gilliland, n/a1, Amol Bhatki, MD2, Ivan Vrcek, MD1, Grant Gilliland, MD1.
1Texas Ophthalmic Plastic Surgery Assoc., Dallas, TX, USA, 2Baylor University Medical Center, Dallas, TX, USA.

PURPOSE: Using a state of the art High Definition video animation we present our technique for orbital decompressions for patients with severe thyroid orbitopathy that minimizes complications while maximizing the amount of decompression. This method involves advancing the lateral orbital wall combined with endoscopic medial wall decompression in such a way as to promote osseous union and minimize cosmetic deformities. Stereotactic intraoperative navigation is utilized in all patients to minimize complications.
METHODS: This paper represents a case series of over 150 orbits where orbital decompression for severe thyroid related orbitopathy was performed in a graded balanced manner. All patients were treated via a graded balanced orbital decompression with advancement of the lateral orbital wall with interpositional bone grafts. Preoperative and postoperative measurements were tabulated and statistically analyzed.
RESULTS: All patients demonstrated significant improvement in proptosis with an average Hertel exophthalmometry reduction of 9 mm. The reduction in Hertel readings varied based on preoperative measurements and postoperative goals thereby demonstrating the “graded balanced” nature of our decompression technique. In addition, all patients with preoperative elevation of intraocular pressure demonstrated a reduction to within the normal range. Less than 5 percent of patients required post orbital decompression strabismus surgery. Of all patients, more than 70% demonstrated improvement of visual acuity of greater than 1 line. Postoperative computed tomography scan demonstrated osseous union of the lateral wall after advancement with this new technique.
CONCLUSION: The graded balanced orbital decompression with interpositional bone grafts effectively decompressed the orbit with significant improvement in final visual acuity, exophthalmometry measurements, and final intraocular pressure. In addition, this technique promotes osseous union with minimal cosmetic deformities. This is one of the largest series of a graded balanced orbital decompression with intraoperative navigation and combined orbital and endoscopic orbital decompression. Our customized video animation effectively demonstrates our technique to patients for educational purposes.


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