Correction of post-traumatic orbital deformities: operative techniques and review of 26 patients.

The skeletal reconstruction of post-traumatic orbital deformities includes the zygomatic complex, the nasoethmoid area and the internal orbit. Repositioning of the malpositioned zygoma is the key element and the first step. Due to remodelling processes, most of the landmarks for proper positioning are lost, leaving the lateral orbital wall as the only reliable landmark in secondary revisions. The details of the skeletal reconstruction are discussed. Between January 1988 and December 1992, 31 patients with major post-traumatic orbital deformities have been operated on, of which 26 could be followed for a minimum of 6 months. A total of 61 operative procedures using craniofacial techniques have been performed. Complications occurred in 5 (15%) of the 26 patients, the most severe being visual loss caused by a displaced bone graft. The most frequent deformity was enophthalmos. Most patients presented with more than one deformity. The aesthetic results were rated as 'good' in 12, 'satisfactory' in 8 and 'unsatisfactory' in 6 patients. Of the patients suffering from double vision, 55% were improved after orbital reconstruction. Craniofacial techniques allow radical correction of post-traumatic skeletal deformities. The functional and aesthetic results, however, are limited by the soft tissues.