Management of Orbital Floor Fractures

AbstractFractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. Repair of these injuries should be carried out with the goal of restoring normal orbital volume, facial contour, and ocular motility. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. This article aims to review concepts on the management of orbital floor fractures in the hope of further elucidating perioperative evaluation and decision-making regarding operative intervention.

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Orbital Volume Correction in Orbital Floor Fractures: A Comparison of Transorbital and Transantral Techniques

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2019.10.028 ◽

2020 ◽

Vol 78 (3) ◽

pp. 430.e1-430.e7 ◽

Cited By ~ 2

Author(s):

Peter Dennis ◽

Akshay Govind ◽

Shaban Demirel ◽

Melissa Amundson

Keyword(s):

Orbital Floor ◽

Volume Correction ◽

Orbital Volume ◽

Orbital Floor Fractures

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Our experience of using the second crease Blepharoplasty incision at the mid-Yorkshire NHS trust to access and repair orbital floor fractures. A discussion of the adequacy of exposure, perioperative and long term complications of this approach

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2016.11.150 ◽

2016 ◽

Vol 54 (10) ◽

pp. e118

Author(s):

Jonathan Kelly ◽

Hira Nazir ◽

Sunil Sah

Keyword(s):

Orbital Floor ◽

Orbital Floor Fractures

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Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study

The Open Dentistry Journal ◽

10.2174/1874210601812010377 ◽

2018 ◽

Vol 12 (1) ◽

pp. 377-387 ◽

Cited By ~ 4

Author(s):

Thomas Starch-Jensen ◽

Linda Busk Linnebjerg ◽

Janek Dalsgaard Jensen

Keyword(s):

Surgical Intervention ◽

Mouth Opening ◽

Orbital Floor ◽

Radiographic Examination ◽

Rigid Fixation ◽

Ocular Motility ◽

Facial Contour ◽

Complex Fractures ◽

Intraoral Approach ◽

Ocular Movement

Objective:Evaluate the 1-year treatment outcome of zygomatic complex fractures with surgical or nonsurgical intervention.Materials and Methods:One hundred and forty-two consecutive patients with a zygomatic complex fracture were enrolled. Sixty-eight patients underwent surgical intervention and 74 patients nonsurgical intervention. The 1-year examination evaluated cosmetic and functional outcome including malar symmetry, ocular motility, occlusion, mouth opening, neurosensory disturbances, and complications.Results:Forty-six patients allocated to surgical intervention responded to the 1-year follow-up examination. Satisfying facial contour and malar alignment was observed in 45 patients. All patients presented with identical position of the eye globe without enophthalmos and normal ocular movement. A habitual occlusion was seen in all patients with a mean interincisal mouth opening without pain of 49 mm. One patient presented with minor ectropion. Wound infection occurred in five patients. Persistent infraorbital neurosensory disturbance was described by 19 patients. The 1-year radiographic examination showed adequate fracture alignment in all patients with satisfying facial contour. However, dissimilar position of the orbital floor was seen in three patients having orbital reconstruction. None of the patients were re-operated or needed secondary correction of the zygomatic complex or orbital floor.Conclusion:Surgical intervention is an effective treatment modality of depressed zygomatic complex fractures, whereas a nonsurgical approach is often used for nondisplaced fractures. Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid fixation at the zygomaticomaxillary buttress. Further exposure of the zygomaticofrontal junction or inferior orbital rim is necessary for severely displaced fractures, which require additional fixation.

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Long-term experience with endoscopic intraoral plating of orbital floor fractures

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2017.02.264 ◽

2017 ◽

Vol 46 ◽

pp. 73

Author(s):

M. Abba ◽

O. Nahlieli ◽

A. Zagury

Keyword(s):

Orbital Floor ◽

Orbital Floor Fractures ◽

Long Term Experience

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Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models

Journal of Clinical Medicine ◽

10.3390/jcm10163509 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3509

Author(s):

Guido R. Sigron ◽

Marina Barba ◽

Frédérique Chammartin ◽

Bilal Msallem ◽

Britt-Isabelle Berg ◽

...

Keyword(s):

Titanium Implant ◽

Cosmetic Outcome ◽

Orbital Floor ◽

Surgical Reconstruction ◽

Patient Specific ◽

Ocular Motility ◽

Titanium Mesh ◽

Anatomical Models ◽

Orbital Floor Fractures ◽

3D Printed

The present study aimed to analyze if a preformed “hybrid” patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture’s shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called “hybrid” patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when “hybrid” patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery’s timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.

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