Combined Orbital Fractures: Surgical Strategy of Sequential Repair

Abstract

BackgroundReconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes.MethodsWe divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant.ResultsIn the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed.ConclusionsWe recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.

New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study

“…25 Fracture in the inferomedial buttress has also been reported to lead to orbital deformity. 26 In this study, we did not find any statistical difference in the degree of the displacement of the orbital bulge or the dislocated fracture in the inferomedial buttress when comparing patients with late visible versus nonvisible deformity.…”

Restoration of the inferomedial orbital strut using a standardized three‐dimensional printing implant

“…Because an orbital fracture is a common facial fracture, a ready-made standardized implant with a precise anatomical contour is advantageous for practical application without additional cost, time and labor. The focus of the present study, therefore, was on obtaining the anatomical dimensions of the orbit, especially of the complicated structure of the IOS, because a ready-made implant is needed to overcome the lack of structural support in the fractured IOS (Su & Harris, 2006;Hur et al 2015). It began with the extraction of the shape of the IOS from an average skull model.…”

“…The inferomedial orbital strut (IOS) is the thin, triangular bony junction of the orbital medial wall and floor (Yao et al 2016). The orbital medial wall and floor are the two most frequently fractured sites of the orbit (Hur et al 2015), and complex fractures involving the IOS are common (Manolidis et al 2002;Gooris et al 2017). The IOS represents a crucial anatomical area in the orbit, and its fracture can result in serious and visible enophthalmos, globe dystopia and diplopia (Goldberg et al 1992;Wright et al 1999;Jordan & Anderson, 2000;Stathopoulos & Ameerally, 2018).…”

Surgical Approach in the Repair of Four Different Orbital Wall Fractures and Results in Four Years

“…Önemli olan bu materyallerin güvenirliliği, esnekliği, dayanıklılığı, doku ile uyumu ve tabi ki uygun fiyatıdır. [27][28][29][30] Literatüre bakıldığında, kemik gibi otolog greftlere oranla "Medpor" ve titanyum implantlar daha çok tercih edilmektedir. 30 Moon ve ark.…”

“…[21][22][23][24][25][26][27][28][29][30][31][32] Peroperatif olarak perioküler kas, orbital damar ve sinir yaralanmaları, özellikle "blow out" fraktürle-rinde infraorbital sinir hasarı, posterior yerleşimli fraktürlerde optik sinir hasarı gibi birçok hasar gelişebilmektedir. Postoperatif erken dönemde, orbital kanama ve neticesinde gelişebilecek orbital kompartman sendromu, kullanılan implant materyallerinin yer değişimi ve ekstürzyonu, nazolakrimal sistem hasarı, transkonjonktival veya transkarünkü-ler yaklaşımla yapılan cerrahi tamirlerde konjonktival hasar ve sineşiler gelişebilmektedir.…”