orbital floor fracture repair
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. Some surgeons report good results with an early repair.
Orbital Fracture Repair Plastic Surgery Key
Titanium meshes and bone grafts are radiopaque.
. It is accomplished intraorally without visible scarring. Some orbital floor fractures may be minor and not require operative treatment. Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials.
Timing of orbital floor fracture repair surgery is critical as orbital and cheekbone fractures may heal quickly. Children with orbital fracture and oculomotor dysfunction tend to have a more favorable outcome if the repair is done within the first 7 days. More commonly titanium meshes porous polyethylene sheets or autologous bone grafts.
Relative indications for surgery are high-risk fractures for enophthalmos which involve over one-half of the orbital floor or lateral orbital wall. However titanium meshes add to the cost of the surgery while bone graft requires additional graft donor site. Proaches allow repair of orbital floor fractures without facial scars and without risk of ectropion.
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. The timing and treatment indications for orbital floor fractures are evolving. Appropriate timing is based on the clinical exam and imaging.
3-6 Surgical repair of the blowout fracture includes the. Can be without clinical evidence of extraocular muscle entrapment OPRS 2009. Oculocardiac reflex bradycardia and nausea from traction on orbital contents with significant herniation of orbital contents.
During the management of floor fractures the clinician should keep in mind the following question. What is the cause of diplopia after surgical repair of an orbital floor fracture. The orbital rim is exposed by one of the approaches mentioned earlier.
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. They also allow for immediate fracture repair without the need to await resolution of edema. Titanium meshes and bone grafts are radiopaque.
Orbital floor fracture repair might be indicated in this setting for small or medium sized defects. Ikeda et al10 suggested the least invasive method was. The trans-antral approach is a reliable approach for the treatment of orbital floor fractures.
The only truly modifiable variable was the material used for orbital floor repair. Early decompression is favorable for neural restitution. 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.
Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials. Visualization in particular across the orbital floor as far as the palatine process appears to be superior to that achieved with other approaches. 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.
Treatment for Orbital Fracture comprises of surgery in severe cases and ice packs rest and antibiotics in mild fractures. 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.
Alloplastic prostheses should be used but if large or comminuted fractures are involved bone grafting is an interesting first choice. Orbital floor fracture repair surgery is most frequently performed with an open technique in which skin incisions are necessary. Concomitant orbital and maxillofacial fractures are repaired in a particular sequence.
Nonresolving oculocardiac reflex the white-eyed blowout fracture and early enophthalmos or hypoglobus are indications for immediate surgical repair. The endonasal approach described here allows orbital floor fractures to be repaired without injury to the eyelid apparatus. 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.
Surgery within 2 weeks is recommended in cases of symptomatic diplop. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor. 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.
The following review will discuss the management of orbital floor fractures with the operative method preferred by the author. Several endoscopic approaches have been taken for re-pair. 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 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. The first step is to obtain a baseline ocular motility by a forced duction test. Depending on the amount and severity of dislocation around the course of the infraorbital nerve decompression might be indicated.
Repair of an orbital floor defect proceeds in a similar manner regardless of approach. 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. Medial orbital wall fractures are known to occur concomitantly with floor fractures.
More commonly titanium meshes porous polyethylene sheets or autologous bone grafts.
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