Orbital Floor Fracture
An orbital floor fracture refers to the deformity of the bones of the eye socket, usually caused by facial trauma. In order to understand orbital floor fractures, it is important to understand the underlying anatomy of the orbital floor. The orbital floor (inferior wall or base of the eye socket) is made up of the intercalating maxillary, zygomatic and palatine bones. The orbital floor measures 35-40 mm and contains a small section of bone wall which is only 0.23 mm thick, thus predisposing the orbital floor to fractures.
What are the different kinds of orbital floor fractures?
Orbital floor fractures are of two types:
- Open door fractures – An open door fracture is said to have occurred when the bones are fractured into several fragments, significantly displaced from their normal positions.
- Trapdoor fractures – In the case of trapdoor fractures, the orbital floor bones are fractured in a hinged manner, with minimal
What causes orbital floor fractures?
In most cases, orbital floor fractures are caused by medium or high-velocity trauma to the orbital floor. Orbital floor fractures often occur in conjunction with other facial fractures such as nasal fractures as a result of physical trauma or motor accidents. It may also be caused by accidental sports injuries from high-velocity objects such as squash and tennis balls.
What are the consequences of an orbital floor fracture?
Due to the fracture of the orbital floor, the volume of the orbit increases. This may lead to displacement of the eye in the backward (enophthalmos) or downward direction (hypoglobus). Muscles or tissue within the eye can get enmeshed in the fracture which may cause an obstruction in gaze and double-vision. Orbital haemorrhage and damage to the optic nerve may occur. Rupture of the eyeball, swelling in the retina and varying degrees of vision loss could take place.
How is an orbital floor fracture treated?
- Medical therapy – Treatment with drugs unaccompanied by surgery can be employed for patients who do not present with significant displacement of the eye, patients who do not appear to have any muscle entrapment in the fracture, have greater than 50% of the orbital floor intact and do not experience double vision. A short course of antibiotics and steroid medication can be used to reduce the chances of infection and suppress any swelling or oedema.
- Surgical therapy – The aim of surgical procedures in the treatment of orbital floor fracture is to examine the affected area and restore any displaced or enmeshed tissue to its correct location in order to correct any extraocular motility. Removal and replacement of bony fragments can also be carried to re-establish the correct orbital volume and shape. The most preferred method for orbital floor reconstruction surgery is the transconjunctival approach. The advantages of this procedure are the lack of visible scarring and the decreased possibility of retraction of the lower eyelid. Other surgical approaches include the cutaneous and transantral Minimally invasive endoscopic methods via transnasal and transmaxillary routes have also been reported. In many cases, orbital implants can also be used by the oculoplastic surgeon in order to reconstruct the orbit. These implants can be fabricated from materials such as vicryl mesh, porous polyethylene, metallic mesh and metallic plates. In certain cases, autologous bone from the maxillary wall and calvaria can also be employed.
What are the complications in the surgical treatment of orbital floor fractures?
- Performing the corrective operation too early – In several cases of orbital floor fracture, the resulting double vision may resolve itself in a few days or may cease to interfere with the normal activities of the patient. In such cases, deciding to wait for one or two weeks before surgery is the most promising course of action.
- Severe postoperative scarring of the eyelid – Malposition of the lower eyelid in case a subciliary incision is performed for the fracture may result in postoperative complications which may be very difficult to treat or correct.
- Incomplete posterior coverage of the bony defect with the implant – The orbital implant material should be placed such that the entire defect is covered. This prevents herniation of the orbital tissue from any gaps remaining in the orbital floor, which may cause further complications.
- Visual loss – One of the complications of the surgical procedure is indirect damage to the optic nerve, thereby causing postoperative visual deficiency.
- Other complications such as double vision, enophthalmos may persist well after surgery.
Orbital floor fracture or orbital blowout fracture is a type of facial fracture caused due to trauma from injuries or motor vehicle accidents. The impact of the trauma results in the fracture of the bones of the eye socket, resulting in the increased volume of the orbit. This results in a range of complications ranging from double vision to displacement of the eye. Medical treatment may provide relief to certain patients; however, surgical repair is necessary in most cases.
Due to the fragile nature of the eye socket and the sensitive location, there are risks and complications involved in orbital floor fracture repair. Patients must be careful to seek treatment from highly experienced and skilled oculoplastic surgeons with prior exposure to orbital surgery.
Dr. Debraj Shome is a highly experienced oculoplastic surgeon based in India. He has various accolades and medical distinctions to his name.
What to do in case of eye socket fracture surgery
If a person has been hit by a high-speed object which he didn’t see coming, then it may cause an eye socket fracture or orbital fracture. It is essential to go to a doctor as soon as the eye socket injury has taken place, for eye socket fracture surgery. Of course, whether or not there is actually any need of getting eye socket fracture surgery is something the doctor will examine and advise.
How does eye socket fracture happen
It can be safely said that avoiding a high-speed object if it comes flying at your head without you being aware of it or having seen it is almost impossible. If the orbital area has faced a blow or a trauma with a projectile or even a road traffic accident, there is a good chance that an eye socket fracture may have happened. This means that the underlying orbital area has been damaged or wounded. That is why it is extremely critical to get immediate treatment for eye socket fracture, as soon as possible. If eye socket fracture surgery is done as soon as possible, then chances of permanent vision damage or other serious consequences may be averted. In fact, if the blow has been serious, then it may even lead to life threatening complications, if not treated as early as possible.
If there has been a direct blow to the orbital area, then eye socket fracture surgery is something that one may need imminently. It is important to understand that the socket of the eye is responsible for protecting the eyeball and if it has been damaged, immediate surgery or intervention is something that might be necessary. The more it is delayed, the higher the consequences. If the injury is very serious, it may even lead to a puncturing of the eyeball and loss of vision, which is something no one wants.
When to visit the doctor?
It is important to see the doctor as soon as possible after the car crash, high-speed collision or shooting has taken place. This will ensure that little time is wasted before the patent is either sent home or taken for eye socket fracture surgery. Here are some of the symptoms that eye socket fracture surgery may be something that will be recommended by the doctor:
- The appearance of the eyes seem sunken
- There is pain when one is trying to move the eyes normally
- Sensitivity to light
- The eyelid movement is irregular
- Double vision
- Blood can be seen in the white part of the eyes
- The area around the eyes is numb
Do understand that an eye injury can be a very serious thing and certainly not something that should be ignored. That is why it is important to see the doctor as soon as possible to rule out the need of an eye socket fracture surgery.
An oculoplastic surgeon is the best person to see for eye socket fracture surgery
If there has been a problem with your eye socket (car crash, or a high-speed collision) then the best person to help you with it will be a highly experienced and skilled oculoplastic surgeon like Dr. Debraj Shome at The Esthetic Clinics. He will be able to gauge whether you should go for eye socket fracture surgery. Living with pain and numbness because the socket of your eyes have been damaged due to some reason or other is something you just shouldn’t be doing and as such visiting such a surgeon as early as possible is a great idea. If you do not get proper and speedy treatment for eye socket fracture, chances are that it may already be too late for surgery and you may lose your vision permanently. An oculoplastic surgeon is the best person to see in this regard because not only is he knowledgeable about the eye, which is one of the most complicated of structures in the human body, but he is also trained in orbital surgery and treatment of fractures of the orbit and the face. If he says that surgery is the only option for you, it is a good idea to get it done without delay, because a delay could mean more serious consequences.
Choosing a good oculoplastic surgeon for eye socket fracture surgery
It is important that you choose a good surgeon to decide whether or not surgery would be right for you. However, it is understandable that you don’t invest a lot of time if you have faced such an injury and awaiting surgery. However, there are a few things that you should keep in mind. If you are planning to get surgery done, then choosing a surgeon, like Dr. Debraj Shome, who has enough experience with eye socket fracture is extremely essential. Apart from checking out the credentials of the professional, you should take note whether he has experience in performing this particular surgery and how high his success rate is. If you keep these few things in mind, chances are that the eye socket fracture surgery and orbital fracture repair will be a successful one.
- Post-Operative care after the oculoplastic surgery
Oculoplastic surgery for orbital floor fracture is a complicated and risky procedure and therefore when the surgery is over you need to take some special post-operative care. If you take proper after care after any oculoplastic procedure then you will be able to enjoy better results.
Oculoplastic procedures deal with the eye, therefore before the surgery discuss with the doctor about the care you will need to take after the oculoplastic operation. The care instructions for oculoplastic procedures are simple and easy to follow.
Before you will be discharged from the oculoplastic surgery for orbital floor fracture, you will be checked for visual acuity. Pain in the periorbital structure is normal however you will be briefed that if the pain worsens after the surgery you should immediately see the oculoplastic surgeon. Also if there is any kind of sudden swelling after the oculoplastic procedure then you have to report to the surgeon immediately.
After the oculoplastic surgery, when you go to sleep, keep your head elevated, this will decrease the postoperative edema. You will also be advised to use cold packs which you should use and they will give you great comfort after the oculoplastic surgery. Avoid blowing nose and lifting heavy weights, for at least two weeks after the oculoplastic surgery for orbital floor fracture. If the oculoplastic surgeon prescribes some ointments to you, then use them regularly.
- When reconstructing the orbital floor during the oculoplastic surgery, there are various kinds of implants that can be used. These include autogenous implants and alloplastic materials. The type of implant that is selected for the oculoplastic surgery will depend on the patient’s age, the type of fracture and the location of the fracture and will be decided by the oculoplastic surgeon. There are some patient specific oculoplastic implants that can be developed using the CT scan data. These kinds of implants reduce the need of intra operative manipulation during the oculoplastic procedure, which gives a better finish to the implants.