Page 104 - Advanced concepts in orbital wall fractures

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Chapter 6
The globe and the ocular muscles receive ligamental support from a network of connective tissue septa that are attached to the orbital walls3. The goal of orbital reconstruction is to restore the anatomical contour of the orbital walls to provide support to the orbital soft tissue, while entrapped orbital muscles and fat tissue are released and repositioned. By restoring the orbital volume, the surgeon aims for a better projection of the globe32,33.
Morbidity in orbital surgery may be severe and incapacitating. The three most common iatrogenic sequelae are enophthalmos, diplopia, and infraorbital nerve hypesthesia34. Entropion, ectropion, and visible scarring may occur as a result of surgical access35. The worst-case scenario is visual impairment and blindness following optic neuropathy, caused by pressure due to retrobulbar hemorrhage or careless surgical handling36. All these factors influence the choice in favour or against orbital reconstruction after orbital trauma.
Nonsurgical treatment relies on the regenerative capacity of the body. Periorbital soft tissue oedema, emphysema, and haematoma in general decrease gradually in the first few weeks6. The contused ocular muscles and nerves may also recuperate. All these conditions lead to temporary muscle imbalance and double vision37,38. In the long term, adaptability of the brain may reduce diplopia through a binocular fusion mechanism39. Adhesions, fibrosis, and atrophy may impair the recovery of diplopia and possibly induce enophthalmos.
The objective of this study was to monitor the outcome of an updated conservative clinical protocol for pure orbital floor and/or medial wall fractures. The aim was to produce a standardised, multidisciplinary, clinical treatment protocol.