Faculty Collaboration Database

Orbital blow-out fractures: surgical timing and technique. Eye (Lond) 2006 Oct;20(10):1207-12

Date

10/05/2006

Pubmed ID

17019420

DOI

10.1038/sj.eye.6702384

Scopus ID

2-s2.0-33749493577 (requires institutional sign-in at Scopus site)   75 Citations

Abstract

PURPOSE: 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.

METHODS: Traditional guidelines for surgical timing are reviewed. An evidence-based approach that considers soft-tissue disruption relative to bone-fragment separation is presented. The author's techniques for repair of isolated orbital floor, isolated medial wall, and combined floor-medial wall fractures are presented.

RESULTS: As 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. There is a suggestion that earlier intervention for such injuries might improve outcomes. Lower fornix and transcaruncular incisions, careful extrication of incarcerated tissue, and thin alloplastic implants have proven successful in the author's hands.

CONCLUSIONS: 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. Incisions, soft-tissue handling, and implant material, thickness, and positioning can all affect the functional and aesthetic outcomes.

Author List

Harris GJ

Author

Gerald J. Harris MD Professor in the Ophthalmology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Esthetics
Evidence-Based Medicine
Humans
Orbital Fractures
Prostheses and Implants
Soft Tissue Injuries
Time Factors
Tomography, X-Ray Computed
Treatment Outcome