Abstract
Orbital decompression is an established procedure used to correct exophthalmos that
results from excess orbital soft tissue. This study aimed to explore a new minimally-invasive
technique that features three-dimensional planning and patient-specific implants for
lateral valgisation (LAVA) of the orbital wall. We analysed the outcomes of this procedure
in nine endocrine orbitopathy (EO) patients (32–65 years of age with a mean clinical
activity score of 4.3) who underwent this procedure between 2021 and 2022, including
seven patients diagnosed with dysthyroid optic neuropathy. The impact of LAVA and
wall resection on orbital areas, volumes, Hertel values, visual acuity, and new-onset
diplopia was determined. Among our results, we found that LAVA and resection of 18
orbital walls resulted in significant enlargement of the orbital volume from a preoperative
mean of 30.8 ± 3.5 cm3 to a mean of 37.3 ± 5.8 cm3 postoperatively (mean difference, 6.2 ± 1.8 cm3; p < 0.001); this procedure also resulted in a significant reduction in the mean Hertel
value, from 28.7 ± 1.9 mm to 20.0 ± 1.9 mm (mean difference, 8.7 ± 1.9 mm; p < 0.001). The procedure resulted in visual acuity declined in three patients (33.3
%) with reductions from 0.25 to 0.125, 0.8 to 0.125, and 1.2 to 0.7, respectively.
No new diplopia occurred postoperatively, however, our study included five patients
with preoperative diplopia that did not improve postoperatively and required additional
surgical intervention. Similarly, four patients required supplemental eyelid surgery.
In conclusion, our study suggests the effects of the LAVA with the partial floor resection
seems to be effective, which provides a substantially improved outcome for patients
undergoing surgical treatment of EO via the use of double navigation and piezosurgical
methods.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
November 15,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.
