orbital floor fracture repair

Some orbital floor fractures may be minor and not require operative treatment. The timing and requirements for surgical repair of pure orbital floor fractures has been long debated.

Orbital Fracture And Eyelid Laceration Surgery Enophthalmos Sunken Eye Before And After Photos Taban Md

Clinical PresentationOrbital Examination 4-8 Orbital floor fractures 4 Initial examination of orbital trauma 4-8 Ocular alignment motility 7 Section III.

. Oculocardiac reflex bradycardia and nausea from traction on orbital contents with significant herniation of orbital contents. Orbital floor fracture repair might be indicated in this setting for small or medium sized defects. Repair is typically via a transconjunctival approach.

Incomplete removal of extraocular muscles and associated orbital tissues from the fracture site prior to implant. Other indications vary but most surgeons will repair fractures within 2 weeks if one or more of the following criteria are met. 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.

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. 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. Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials.

Can be without clinical evidence of extraocular muscle entrapment OPRS 2009. To assess the feasibility and the outcome of endoscopically assisted repair of zygomatico-maxillary complex orbital fractures in a tertiary care hospital. A descriptive study was carried out over a period of 2 years 01.

The endonasal approach described here allows orbital floor fractures to be repaired without injury to the eyelid apparatus. Titanium meshes and bone grafts are radiopaque. In addition LactoSorb and polyamide sheeting are adequate for the repair of simple 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. 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. Appropriate timing is based on the clinical exam and imaging.

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. 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. Orbital floor fracture repair surgery is most frequently performed with an open technique in which skin incisions are necessary.

Orbital Fracture Repair Case Study. Visualization in particular across the orbital floor as far as the palatine process appears to be superior to that achieved with other approaches. More commonly titanium meshes porous polyethylene sheets or autologous bone grafts.

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 lateral canthotomy is then performed with a 15 blade followed by an inferior cantholysis. Eye socket fractures most commonly occur on the floor of the socket the most vulnerable area.

Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly. Khalifehs preferred approach for fixing orbital floor defects is the transconjunctival approach. While there is usually intense pain when the impact occurs many orbital fractures quickly recover and may not have much pain at all.

However titanium meshes add to the cost of the surgery while bone graft requires additional graft donor site. This is one of many clinical factors in assessing the return to normal activities. The authors now let patients resume normal activities approximately 3 weeks after uncomplicated orbital floor fracture repair.

Early decompression is favorable for neural restitution. Transconjunctival Minimal Scar Repair Dr. Indications for Surgical Repair 9 Immediate 9 Early repair - 5 to 10 days 9 Observation 9 Section IV.

There are several reasons to repair blowout fractures. Alloplastic prostheses should be used but if large or comminuted fractures are involved bone grafting is an interesting first choice. Entrapment of the orbital tissue by the placement of an implant.

Forced ductions are checked which are shown to be restricted in supraduction. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor. Diplopia within 30 of primary gaze associated with a positive forced duction test clinically significant enophthalmos greater than 2 mm and a fracture size greater than 50 of the orbital floor.

A direct impact to the face when playing sports during a fight or in an auto accident can fracture the bone. Orbital floor strength is regained 24 days after repair. 3-6 Surgical repair of the blowout fracture includes the.

Some orbital floor fractures may be minor and not require operative treatment. This video demonstrates repair of a left orbital floor fracture. This video illustrates the use of porous polyethylene implant stabilized with cyanoacrylate glue to repair an orbital floor fracture by the transconjunctival.

0-4 mm endoscopes were used for intra-operative endoscopic exploration. Most literature supports a 2-week window for repair to prevent fibrosis resulting tissue. 40 silk sutures are placed through the lower eyelid at the level of the tarsus.

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. Depending on the amount and severity of dislocation around the course of the infraorbital nerve decompression might be indicated. The only truly modifiable variable was the material used for orbital floor repair.

Surgical Technique 10-12 Surgical approaches to the orbital floor 10. Medial orbital wall fractures are known to occur concomitantly with floor fractures. Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly.

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.

Right Orbital Floor And Medial Wall Fractures With Surgical Implant Repair