$orbital blowout fracture$

$orbital blowout fracture$

Hence, proper training and adequate experience are critical for any surgeon undertaking orbital fracture repair. Orbital surgery is inherently difficult because it is performed within a tight space around the eye and other vital tissues. Far more important than the type of implant is the use of sound surgical technique when exposing the fracture, repositioning the tissues, and placing the implant. Available implant materials vary widely, and they all have their own advantages and disadvantages. Orbital blowout fractures are repaired by surgically entering the orbit, repositioning the herniated tissues, and covering the bony opening with a thin implant. This is also a matter of preference and some patient-specific risk factors. During the waiting period, some doctors prescribe steroids and/or antibiotics. Some surgeons recommend early repair if a fracture looks large enough on CT scan, but this is largely a matter of preference. As long as muscle entrapment is not present, it is perfectly acceptable to observe a patient for several weeks to see if double vision improves on its own, or if enophthalmos develops once the orbital swelling from the initial trauma subsides. It is important to emphasize that not all orbital fractures need to be repaired. While enophthalmos does not affect vision, it can alter a patient’s facial appearance enough to warrant reconstructive surgical repair. Unlike most orbital fractures, which can be safely observed for several weeks or longer, trap door fractures must be repaired within a day or two to prevent permanent muscle damage.Īnother common problem caused by orbital fractures is a sunken appearance of the eye, for which physicians use the term “enophthalmos.” This occurs when enough orbital tissue bulges through a fracture into the adjacent sinus to cause the eye to sink back into the socket, or sometimes even downwards, in the case of large floor fractures. This is much more common in children or young adults, whose bones are not as brittle as older people’s, and the fractured orbital bone can bend to form a “trap-door” which pinches the muscle between two pieces of bone. The most serious cause of diplopia occurs when muscle gets entrapped by or impaled on bone fragments. In these cases, the double vision is often only present when looking up, down, or to the sides, and it can sometimes improve on its own over time. Another cause of diplopia is indirect traction on the muscles from herniation or entrapment of the soft tissues connected to the muscle. In such a situation, only time can determine if the muscle will regain its strength – repairing the fracture will not make the muscle heal any faster. Diplopia can be caused by direct injury (contusion) of the muscle from the same impact that caused the fracture in the first place. One common issue caused by orbital tissue herniation is double vision (diplopia), due to imbalance of the muscles that move the eye. CT scan showing large fracture of the right orbital floor with herniation of the inferior rectus muscle (arrow) into the maxillary sinus.

$orbital blowout fracture$