Panagiotis Stathopoulos1, Philip Ameerally2. 1. Associate Professor, Dublin Dental University Hospital; Consultant Oral and Maxillofacial Surgeon, Mater Hospital, Dublin, Ireland. Electronic address: pan_stath@yahoo.gr. 2. Consultant Oral and Maxillofacial Surgeon, Northampton General Hospital, Northampton, UK.
Abstract
PURPOSE: This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect. MATERIALS AND METHODS: In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity. This approach allowed ample access to the floor and the medial wall of the orbit; therefore, a single 0.5-mm titanium mesh was bent to fit the combined defect for reconstruction. RESULTS: Early combined maxillofacial and oculoplastic surgical intervention resulted in salvage and restoration of the eye with preservation of vision. CONCLUSIONS: Stable reconstruction of the maxillo-ethmoidal buttress is of great importance in patients with comminuted injuries. This strut determines the appropriate orbital volume and defines the position of the eye in space. Patients with insufficient restoration of the buttress are always at risk of developing enophthalmos. To replicate the contour of the S-shape of the orbital floor and the slope of the medial wall, the authors support the use of thin implants with rigid fixation on the bony orbit as the most suitable materials to achieve this. Thick implants can be rather difficult to bend, and when this is attempted several times they are more prone to fractures. Conversely, very thin and flexible implants can always be dislodged and cause late enophthalmos.
PURPOSE: This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect. MATERIALS AND METHODS: In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity. This approach allowed ample access to the floor and the medial wall of the orbit; therefore, a single 0.5-mm titanium mesh was bent to fit the combined defect for reconstruction. RESULTS: Early combined maxillofacial and oculoplastic surgical intervention resulted in salvage and restoration of the eye with preservation of vision. CONCLUSIONS: Stable reconstruction of the maxillo-ethmoidal buttress is of great importance in patients with comminuted injuries. This strut determines the appropriate orbital volume and defines the position of the eye in space. Patients with insufficient restoration of the buttress are always at risk of developing enophthalmos. To replicate the contour of the S-shape of the orbital floor and the slope of the medial wall, the authors support the use of thin implants with rigid fixation on the bony orbit as the most suitable materials to achieve this. Thick implants can be rather difficult to bend, and when this is attempted several times they are more prone to fractures. Conversely, very thin and flexible implants can always be dislodged and cause late enophthalmos.