Orbital Roof Fracture Repair

Many fractures of the orbit a common occurrence with facial trauma never require surgery which is customarily performed in patients with restricted motility diplopia and enophthalmos.

Orbital roof fracture repair.

Alternatively matrix midface screws can be used. Ruptured globe or retinal detachment orbital surgery is usually postponed due to the increased risk this places on the damaged globe. However titanium meshes add to the cost of the surgery while bone graft requires additional graft donor site. In addition to the formal ophthalmic exam a complete orbital exam is required.

The approach used is determined by the surgical needs of the patient. However intracranial or intraorbital injury may warrant surgical intervention to remove impinging bony fragments repair dura or reconstruct the orbital roof. Fracture to the orbital roof may require consultation with a neurologist or neurosurgeon. When the inner table of the orbital roof is not involved and there is no dural tear the orbital fracture can be accessed by superior orbitotomy.

In majority of the cases of orbital fracture the discoloration and swelling begin to subside within a week to 10 days after the injury has occurred. Most can be safely observed. After neurologic repair the displaced orbital roof bone fragments were removed and optic nerve decompression was performed when a bone fragment compressed the optic nerve. Repair of an orbital floor fracture involves bridging of the floor defect using one of the various biomaterials.

More commonly titanium meshes porous polyethylene sheets or autologous bone grafts. Titanium meshes and bone grafts are radiopaque. Rates of open globe in with orbital roof fracture range from 4 9 5. Fixation of orbital reconstruction material varies with the type and nature of the fracture.

If significant globe trauma is identified i e. The orbital roofs were reconstructed using three dimensionally fabricated titanium micromesh plates and microscrews and the associated fractures were then repaired. The healing time of orbital fracture depends on the severity and location of the fracture. When it comes to surgical repair of orbital floor fractures the consensus among oculoplastic specialists is that less is often more.

Approaches include extracranial intracranial and endonasal endoscopic. The diameter depends on anatomical requirements but will normally vary between 1 0 1 3 or 1 5 mm. An interdisciplinary approach with plastic surgery ophthalmology and neurosurgery is crucial to providing comprehensive care.