Orbital proportion indices and microlipografting for correction of secondary post-traumatic enophthalmos

Aim. Aesthetic rehabilitation of patients with secondary post-traumatic enophthalmos.

Methods. From 2013 to 2018, 14 patients with secondary post-traumatic enophthalmos were treated at the maxillofacial surgery clinic of the Azerbaijan Medical University. All patients underwent reconstruction of the damaged orbital wall, so its bone volume was restored. However, in the postoperative period, a deficiency of the orbital soft tissue was noted. In preparation for the surgery, all patients underwent the following types of examination: three-­dimensional computed tomography, photographic, anthropometric measurements with the determination of proportional indices and computer simulation. Based on the data obtained, the orbital proportion indices were calculated: intercanthal index (en-en)×100/(ex-ex); orbital protrusion index (ex-ex)×100/(ex-en,r&l)+(en-en); orbital width index (ex-en,l)×100/(en-en); eye fissure (palpebral) index (ps-pi, l)×100/(ex-en,l); orbital index (os-or,l)×100/(ex-en,l); eyebrow orbital height index (os-or,l)×100/(sci-or,l); index of vertical orbital contour (os-or,l)×100/(ps-os+pi-or)+(ps-pi); eyelid height index (pi-or,l)×100/(ps-os,l). Microlipografting was performed according to the Coleman method with modification by T. Marten. Fat aspiration was performed with a blunt cannula with a diameter of 2.1–2.4 mm and a 10 ml syringe, without anesthetic administration. Prior to microlipografting, fibrotic cords between the skin and underlying tissues were dissected using a sharp needle and a V-shaped cannula. Microlipografting was performed using microcannulas of 0.7–1.1 mm. The fat microtransplant was introduced in two layers: under the circular muscle of the eye and subperiostally in the orbit.

Results. In 11 cases, with an unexpressed form of secondary post-traumatic enophthalmos, a good aesthetic result was recorded. In 3 patients with a pronounced form of enophthalmos, a satisfactory aesthetic result was obtained; in these cases, repeated microlipografting was carried out.

Conclusion. Microlipografting based on the calculation of the orbit proportions indices during rehabilitation of patients with secondary post-traumatic enophthalmos is a minimally invasive and effective procedure.