orbital floor fracture repair

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. Clin Plast Surg 4425-437 1977 repair of orbital floor fractures noting that none of the patients 6.

Right Orbital Floor And Medial Wall Fractures With Surgical Implant Repair

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.

. Relative indications for surgery are high-risk fractures for enophthalmos which involve over one-half of the orbital floor or lateral orbital wall. The repair of the orbital floor fractures is not without risks which must be taken into consideration when surgery is decided as a treatment of choice. The timing and treatment indications for orbital floor fractures are evolving.

Appropriate treatment involves optimal timing of intervention proper indications for operative repair incision and dissection release of herniated tissue implant material and placement and wound closure. However titanium meshes add to the cost of the surgery while bone graft requires additional graft donor site. Inferior oblique muscle sheath entrapment within the orbital floor blow-out fracture gap is uncommonly seen but is one of the major indications of surgical repair of the fracture.

40 silk sutures are placed through the lower eyelid at the level of the tarsus. Orbital floor fracture repair might be indicated in this setting for small or medium sized defects. Early decompression is favorable for neural restitution.

Orbital floor strength is regained 24 days after repair. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor. References Bagheri A Tavakoli M Khosravifard K Yazdani S.

Clinical and Radiologic Characteristics of Inferior Rectus Muscle Sheath Entrapment in Orbital Blowout. This is one of many clinical factors in assessing the return to normal activities. There are several reasons to repair blowout fractures.

More commonly titanium meshes porous polyethylene sheets or autologous bone grafts. The only truly modifiable variable was the material used for orbital floor repair. Orbital floor fracture repair surgery is most frequently performed with an open technique in which skin incisions are necessary.

Entrapment of the orbital tissue by the placement of an implant. Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly. Oculocardiac reflex bradycardia and nausea from traction on orbital contents with significant herniation of orbital contents.

Experience with various procedures in the experienced any problems such as infection migration or ex- treatment of orbital floor fractures. Fractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. The first step is to obtain a baseline ocular motility by a forced duction test.

Cho md facs vikram d. The authors now let patients resume normal activities approximately 3 weeks after uncomplicated orbital floor fracture repair. Can be without clinical evidence of extraocular muscle entrapment OPRS 2009.

This video demonstrates repair of a left orbital floor fracture. Concomitant orbital and maxillofacial fractures are repaired in a particular sequence. 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.

Langer md facs W hen it comes to surgical repair of orbital floor fractures the consen - sus among oculoplastic specialists is that less is often more. Depending on the amount and severity of dislocation around the course of the infraorbital nerve decompression might be indicated. 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.

Forced ductions are checked which are shown to be restricted in supraduction. In addition LactoSorb and polyamide sheeting are adequate for the repair of simple floor fractures. Orbital Floor Fracture Repair.

A lateral canthotomy is then performed with a 15 blade followed by an inferior cantholysis. Titanium meshes and bone grafts are radiopaque. Nonresolving oculocardiac reflex the white-eyed blowout fracture and early enophthalmos or hypoglobus are indications for immediate surgical repair.

Appropriate timing is based on the clinical exam and imaging. 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. A significant facial asymmetry imaging evidence of the fracture the age of the patient and clinical signs and symptoms are extremely important in determining the surgical indications.

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. When Less Is More by miriam karmel contributing writer interviewing raymond i. Repair of these injuries should be carried out with the goal of restoring normal orbital volume facial contour and ocular motility.

Some orbital floor fractures may be minor and not require operative treatment. Repair of an orbital floor defect proceeds in a similar manner regardless of approach. Some surgeons report good results with an early repair.

The following review will discuss the management of orbital floor fractures with the operative method preferred by the author. 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. Many fractures of the or-.

Incomplete removal of extraocular muscles and associated orbital tissues from the fracture site prior to implant. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. Surgery within 2 weeks is recommended in cases of symptomatic diplop.

Roncevic R Malinger B. Alloplastic prostheses should be used but if large or comminuted fractures are involved bone grafting is an interesting first choice. Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials.

Durairaj md facs and paul d. The orbital rim is exposed by one of the approaches mentioned earlier. J Maxillofac Surg 981-84 1981 trusion of the implant.

Children with orbital fracture and oculomotor dysfunction tend to have a more favorable outcome if the repair is done within the first 7 days. 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 they avoid artifact from dental amalgam.

Orbital Floor Xilloc

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