orbital floor fracture repair

Subtleties of the position and size of the fracture as well as the age and goals of the patient help the treating surgeon recognize absolute indications and decide on relative indications for surgery. To avoid the dangers associated with lower eyelid approaches to the orbital floor and to improve visualization we propose an endoscopic procedure for orbital floor fracture reduction and osteosynthesis using endonasal access via the medial maxillary sinus wall.

A Case Of Combined Orbital Floor And Medial Wall Fracture A 44 Year Old Download Scientific Diagram

The repair of orbital fractures involves fracture site exposure freeing tissue prolapsed into the fracture site and reapproximating the orbital wall support usually with an implant.

. 40 silk sutures are placed through the lower eyelid at the level of the tarsus. Appropriate timing is based on the clinical exam and imaging. Early decompression is favorable for neural restitution.

As with any surgical procedure bleeding infection and the need for additional surgery are risks. Treatment for Orbital Fracture comprises of surgery in severe cases and ice packs rest and antibiotics in mild fractures. More commonly titanium meshes porous polyethylene sheets or autologous bone grafts.

Incision is made with a 15 blade underneath the lower eyelid on the affected side and hemostasis is achieved. Orbital floor fracture repair should restore orbital volume by replacing orbital tissues to their anatomical position within the orbit and reconstructing the orbital bony anatomy. Nonresolving oculocardiac reflex the white-eyed blowout fracture and early enophthalmos or hypoglobus are indications for immediate surgical repair.

3-6 Surgical repair of the blowout fracture includes the. 1 mobilize obviously entrapped extraocular muscles in cases presenting with positive forced ductions and severe subjective diplopia 2 mobilize a large volume of herniated orbital fat back into the orbit in order to return the globe to its preinjury location in cases where greater than 2mm of enophthalmos and or. Entrapment of the orbital tissue by the placement of an implant.

The planned incision is marked and injected with a local anesthetic containing epinephrine. Incomplete removal of extraocular muscles and associated orbital tissues from the fracture site prior to implant. Orbital floor fracture repair surgery is most frequently performed with an open technique in which skin incisions are necessary.

Repair of orbital floor fracture 1. As in all floor fractures forced ductions are checked prior to starting the surgery. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor.

In this retrospective study of 58 patients 36 eyes repaired within 14 days mean of 9 days were compared with 22 eyes repaired at up to 29 days mean of 19 days. Some orbital floor fractures may be minor and not require operative treatment. Patients suspected of suffering an orbital floor fracture should undergo thin cut 10 - 15mm axial CT scans of the orbit with coronal reconstruction Thin cut coronal reconstructions are actually preferred to direct coronal images as.

CT scan demonstrates common findings of a blow out fracture with evidence of a depressed right orbital floor bottom. Orbital floor fracture repair complications. Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly.

This video demonstrates repair of a left orbital floor fracture. Orbital floor fracture repair surgery is most frequently performed with an open technique in which skin incisions or incisions within the lining of the eyelid are necessary. A toothed forcep used to fixate the globe at the insertion of the inferior rectus muscle.

Allen MD PhD FACS Additional Notes. Orbital floor fracture repair surgery is most frequently performed. Surgery within 2 weeks is recommended in cases of symptomatic diplop.

Orbital floor fracture repair. Orbital floor fracture repair. Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly.

Can be without clinical evidence of extraocular muscle entrapment OPRS 2009. Depending on the amount and severity of dislocation around the course of the infraorbital nerve decompression might be indicated. This video illustrates the use of porous polyethylene implant stabilized with cyanoacrylate glue to repair an orbital floor fracture by the transconjunctival.

A lateral canthotomy is then performed with a 15 blade followed by an inferior cantholysis. A frequently cited study by Dal Canto and Linberg 2 demonstrated that patients fared equally well if their orbital floor fractures were repaired within 14 days or within 29 days after trauma. Orbital fracture is a breakage in the bone in the eye socket which can involve the rim the floor or even both.

Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials. Length 0230 This video demonstrates repair of a left orbital floor fracture. Orbital floor fracture repair might be indicated in this setting for small or medium sized defects.

The possible loss of vision is the most ominous complication associated with floor repair. Titanium meshes and bone grafts are radiopaque. Oculocardiac reflex bradycardia and nausea from traction on orbital contents with significant herniation of orbital contents.

Medial orbital wall fractures are known to occur concomitantly with floor fractures. Surgical reconstruction should account for the complex curvatures of each wall that combine to form a conoid shape with its apex in the superomedial posterior orbit. Orbital floor fracture repair surgery is intended to minimize these potential.

The physicians of the Osborne Head and Neck Institute Division of Facial Plastic and Reconstructive Surgery commonly perform orbital blow out repair procedures. The only truly modifiable variable was the material used for orbital floor repair. However titanium meshes add to the cost of the surgery while bone graft requires additional graft donor site.

The timing and treatment indications for orbital floor fractures are evolving. There are several reasons to repair blowout fractures. 2 Recent clinical studies have recommended prompt surgical repair in patients with large fractures 50 of the orbital floor and in those with disability diplopia or enophthalmos of greater than 2 mm or both 10 to 14 days after trauma.

Any entrapped orbital tissues should be freed from the fracture site at the time of surgery releasing any mechanical strabismus which should be verified at the end of surgery with forced. Alloplastic prostheses should be used but if large or comminuted fractures are involved bone grafting is an interesting first choice. Some orbital floor fractures may be minor and not require operative treatment.

Forced ductions are checked which are shown to be restricted in supraduction.

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