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R. Shinder, P.D. Langer; Incomplete Repair of Orbital Wall Fractures: Clinical Presentation, Radiologic Characteristics, and Surgical Correction . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2482.
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To describe the clinical presentation and treatment recommendations for patients who have undergone incomplete surgical repair of orbital wall fractures.
The charts of patients who were referred following incomplete surgical repair of an orbital fracture were reviewed. Incomplete repair was documented by CT images of the orbital implant placed by the initial surgeon. Clinical presentation, radiologic characteristics, and results of repeat surgery were assessed.
Five patients who underwent repair of an orbital wall fracture were referred with persistent diplopia and/or enophthalmos following their initial surgery. Four patients had undergone repair of an orbital floor ("blowout") fracture, and one patient had undergone the correction of an orbital medial wall fracture. In each of these patients, CT scans revealed that the orbital fracture defect was not completely covered by the implant, leading to persistent tissue herniation into the adjacent sinus cavity through the uncovered portion of the fracture. We recommended surgical removal of the initial implant and complete repair with the placement of a new implant extending to the posterior rim of the fracture site and implant fixation. Surgery was subsequently performed on three of the five patients with elimination or marked improvement of diplopia and enophthalmos. Post–operative CT images in these patients demonstrated the correct placement of the new implant, extending to the posterior edge of the fracture site.
The primary goals in the surgical correction of orbital wall fractures are to reposit herniated orbital tissues and to cover the entire extent of the bony defect with an implant. Patients having undergone surgical repair of orbital fractures who present with persistent diplopia or enophthalmos may have incomplete coverage of the anatomic defect with persistent herniation of orbital tissues; CT is the radiologic modality of choice to investigate this suspicion. If there is radiologic evidence of inadequate fracture repair in symptomatic patients, surgical intervention to remove the initial implant and introduce a new implant to cover the entire extent of the anatomic defect may be curative. Surgeons should be vigilant when repairing orbital wall fractures to completely cover the anatomic bony defect with the orbital implant by insuring that the implant extends to the posterior edge of the fracture site and by fixating the implant.
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