Treatment of orbital floor fracture periorbital approach
PREOPERATIVE DIAGNOSIS: Right orbital floor fracture with entrapment.
POSTOPERATIVE DIAGNOSIS: Right orbital floor fracture with entrapment.
OPERATION: Open reduction of right orbital floor fracture with Supramid implant.
DESCRIPTION OF PROCEDURE: The patient was placed in the supine position. Under satisfactory general endotracheal anesthesia, his face was prepped and draped in a sterile manner, and his lower eyelid was infiltrated with Marcaine with adrenaline. An infralid incision was made extending out into the lateral eyelid skin, and a tunnel was dissected along the infraorbital rim. Skin muscle flap was elevated and retracted with silk sutures. Some orbital fat protruded from the orbital septum medially. This was left alone.
An incision was made in the periosteum over the rim of the orbital cavity, and the periosteum was elevated with a Freer elevator exposing the anterior aspect of the orbit approximately 1 cm posterior to the rim. The defect was encountered in the medial half of the orbit. Periosteum and orbital fat were dissected from the maxillary sinus, also bringing up some fragments of bone which were completely free and loose.
Stable edges of the orbital floor were identified on both sides with a distance between them of about 3 cm. Dissection was continued posteriorly until no further tissue could be lifted from the maxillary sinus. An oval-shaped orbital implant was designed and cut of 0.6 mm Supramid and placed in shape. It was trimmed to conform to the size of the orbital floor.
A small hole was drilled in the mid aspect of the orbital rim to allow a 5-0 nylon suture to be placed to suture this in place. On drilling the first hole, the drill bit broke off, and this was left in place. A second hole was drilled next to it with no difficulty, although there was pus and bleeding after the 5-0 nylon was placed through the hole and through the floor implant. The hole and inferior orbital rim were packed with bone wax. This achieved hemostasis.
The periosteum was then repaired with interrupted 5-0 Monocryl, and this was also used in the subcutaneous layer of the lid. Interrupted 6-0 nylon was placed in the lid. The patient was then awakened and taken to the recovery room in satisfactory condition.