$orbital blowout fracture$

$orbital blowout fracture$

In an extreme example, Emery et al 5 described 49 patients although 43 had surgery within 2 weeks of the injury, almost 50% of the total had diplopia 6 or more months following surgery. However, motility outcomes were less than ideal. In the last two decades, orbital volume outcomes were generally well served using this approach to blow-out fractures. In these cases, motility, rather than volume, is the primary concern, and surgery is usually advised only if there is clinically significant diplopia that does not resolve within 2 weeks. However, at the time of the injury, there was significant transient displacement of bone fragments, which captured soft tissue when they snapped back into position. In fact, some trap-door injuries may appear so well aligned that no fracture is identified by the radiologist ( Figure 1). In this paradigm, a ‘small’ fracture refers to a minimally displaced fracture. If surgery is delayed until enophthalmos is apparent, then fibrosis between orbital soft tissues, sinus mucosa, and bone fragments can make surgery more difficult. Enophthalmos may be obvious at the time of presentation, or it may be masked by oedema or haematoma. If the fracture is large, enophthalmos is anticipated and surgery is usually performed within the first 2 weeks.

$orbital blowout fracture$

4 This approach continues to be used in many centers. The advent of computed tomography (CT) narrowed the poles of the debate, and produced a fairly uniform protocol in the 1980s and 1990s. Soft tissues were displaced or incarcerated, correlating with enophthalmos and restricted motility.įor the next two decades, when diagnosis was based on plain X-rays and hypocycloidal tomography, treatment recommendations ranged from early intervention for all fractures to prolonged observation in all cases, with delayed surgery reserved for late enophthalmos or persistent diplopia. They produced an impact on the orbital soft tissues of a cadaver, increasing hydraulic pressure, and causing the thin, internal walls to fracture. The term ‘blow-out fracture’ was coined in 1957, when Smith and Regan 1 described the mechanism of injury. Incisions, soft-tissue handling, and implant material, thickness, and positioning can all affect the functional and aesthetic outcomes.

$orbital blowout fracture$

The degree of soft-tissue displacement relative to bone fragment distraction, as depicted in preoperative computed tomography (CT) scans, should be considered in the timing of surgery. Lower fornix and transcaruncular incisions, careful extrication of incarcerated tissue, and thin alloplastic implants have proven successful in the author's hands. There is a suggestion that earlier intervention for such injuries might improve outcomes. ResultsĪs demonstrated previously, greater degrees of soft-tissue incarceration or displacement, with presumably greater intrinsic damage and subsequent fibrosis, result in poorer motility outcomes despite complete release of soft tissues. The author's techniques for repair of isolated orbital floor, isolated medial wall, and combined floor–medial wall fractures are presented. An evidence-based approach that considers soft-tissue disruption relative to bone-fragment separation is presented. Traditional guidelines for surgical timing are reviewed. To recommend a tailored approach to surgical timing in the repair of orbital blow-out fractures, and to offer suggestions for improved functional and aesthetic surgical outcomes.

$orbital blowout fracture$

Orbital blowout fracture