Facial Plast Surg 2007; 23(3): 190-199
DOI: 10.1055/s-2007-984559
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Orbital Floor Fractures: Evaluation, Indications, Approach, and Pearls from an Ophthalmologist's Perspective

Gary J. Lelli1  Jr. , James Milite1 , Elizabeth Maher1
  • 1Department of Ophthalmic Plastic and Reconstructive Surgery, The New York Eye and Ear Infirmary, New York, New York
Further Information

Publication History

Publication Date:
10 August 2007 (online)

ABSTRACT

Blunt trauma to the orbital rim is a frequent cause of orbital floor fractures. Although orbital floor fractures often occur in association with other facial trauma, the term “blowout fracture” is reserved for isolated orbital floor fractures with an intact orbital rim. Many surgical specialties-including ophthalmologists, otolaryngologists, maxillofacial specialists, and plastic surgeons-evaluate and treat floor fractures. The wide range of treating physicians means that varying levels of expertise and experience are involved in care of patients with periorbital trauma. Although each subspecialty can offer pearls from their basis of training, the purpose of this article is to offer insights on orbital floor fractures from the ophthalmic plastic and reconstructive surgeon's perspective. Particular emphasis will be placed on ophthalmic portions of the examination and treatment plan; all in an attempt to avoid ophthalmic complications. This review is meant to be a user-friendly guide to the evaluation and treatment of orbital floor fractures from an ophthalmic perspective.

REFERENCES

  • 1 Mauriello J A, Lee H J, Nguyen L. CT of soft tissue injury and orbital fractures.  Radiol Clin North Am. 1999;  37 241-252
  • 2 Burnstine M A. Clinical recommendations for repair of orbital facial fractures.  Curr Opin Ophthalmol. 2003;  14 236-240
  • 3 Jordan D R, Allen L H, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout.  Ophthal Plast Reconstr Surg. 1998;  14 379-390
  • 4 Raskin E M, Millman A L, Lubkin V, Della Rocca R C, Lisman R D, Maher E A. Prediction of late enophthalmos by volumetric analysis of orbital fractures.  Ophthal Plast Reconstr Surg. 1998;  14 19-26
  • 5 Biesman B S, Hornblass A, Lisman R, Kazlas M. Diplopia after surgical repair of orbital floor fractures.  Ophthal Plast Reconstr Surg. 1996;  12 9-16
  • 6 Egan R, Rizzo J F. Neuroophthalmological complications of ocular surgery.  Int Ophthalmol Clin. 2000;  40 93-105
  • 7 Shore J W. The fornix approach to the inferior orbit.  Adv Ophthalmic Plast Reconstr Surg. 1987;  6 377-385
  • 8 Appling W D, Patrinely J R, Salzer T A. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair.  Arch Otolaryngol Head Neck Surg. 1993;  119 1000-1007
  • 9 Patel P C, Sobota B T, Patel N M, Greene J S, Millman B. Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases.  J Craniomaxillofac Trauma. 1998;  4 17-21
  • 10 Baumann A, Ewers R. Use of the preseptal transconjunctival approach in orbit reconstruction surgery.  J Oral Maxillofac Surg. 2001;  59 287-291
  • 11 Canan S, Asim O M, Okan B, Ozek C, Alper M. Anatomic variations of the infraorbital foramen.  Ann Plast Surg. 1999;  43 613-617
  • 12 Chang E W, Manolidis S. Orbital floor fracture management.  Facial Plast Surg. 2005;  21 207-213
  • 13 Chowdhury K, Krause G E. Selection of materials for orbital floor reconstruction.  Arch Otolaryngol Head Neck Surg. 1998;  124 1398-1401
  • 14 Lee S, Maronian N, Most S P et al.. Porous high-density polyethylene for orbital reconstruction.  Arch Otolaryngol Head Neck Surg. 2005;  131 446-450
  • 15 Ng S G, Madill S A, Inkster C F, Maloof A J, Leatherbarrow B. Medpor porous polyethylene implants in orbital blowout fracture repair.  Eye. 2001;  15 578-582
  • 16 Rubin P A, Bilyk J R, Shore J W. Orbital reconstruction using porous polyethylene sheets.  Ophthalmology. 1994;  101 1697-1708
  • 17 Merbs S L, Iliff N T, Grant M P, Garibaldi D C. Use of the Medpor Titan implants in orbital reconstruction. Poster presentation at the Association for Research in Vision and Ophthalmology: Fort Lauderdale, FL May 2005
  • 18 Gilhotra J S, McNab A A, McKelvie P, O'Donnell B A. Late orbital haemorrhage around alloplastic orbital floor implants: a case series and review.  Clin Experiment Ophthalmol. 2002;  30 352-355
  • 19 Rosen C E. Late migration of an orbital implant causing orbital hemorrhage with sudden proptosis and diplopia.  Ophthal Plast Reconstr Surg. 1996;  12 260-262

Gary J LelliJr. M.D. 

310 East 14th Street

New York, NY 10003

    >