Page 13 - Advanced concepts in orbital wall fractures

General introduction C1
To take the next step in the management and treatment of orbital wall fractures, also called blow-out or orbital floor and medial wall fractures, it is helpful to be aware of the scientific developments of the past. In 1982, doctor K. de Man was the first Dutch oral and maxillofacial (OMF) surgeon to write a PhD thesis on orbital wall fractures1. Some of his most important findings were: that an important indication for orbital reconstruction is a significant limitation in vertical eye movement combined with a positive forced duction test or significant herniation of orbital tissue into the maxillary sinus. If the periorbita is intact, there is no indication for orbital reconstruction. He concluded that there is a need for individualised treatment in orbital wall fractures, as there is no single method of treatment that can be considered ideal. In the same period, ophthalmologist professor L. Koornneef did revolutionary anatomical and histological research on the musculofibrous network of the orbit2. He advocated a conservative approach in the management of orbital wall fractures, while others favoured early surgical intervention3.
Research at the orbital unit of the Department of OMF surgery at the Amsterdam UMC location AMC started in 2012 and focused on advanced technological concepts of orbital reconstruction and the management of orbital wall fractures. Since the beginning, medical engineers were part of the research team. Efforts resulted in a series of systematic reviews on the current controversies in orbital reconstruction4-6. Another line of research was centred around navigation-assisted orbital reconstruction and advanced solutions, such as a patient-specific implant (PSI)7,8. The first milestone was the PhD thesis of doctor L. Dubois in 2016. This PhD thesis is a continuation of the research performed at the OMF surgery orbital unit, partly in collaboration with the Department of Ophthalmology.
Orbital anatomy and trauma mechanism
Comprehensive knowledge of the anatomy and the trauma mechanism is essential to understand the challenges in the treatment of orbital floor and medial wall fractures. The bony components of the orbit originate from seven surrounding bones: frontal, lacrimal, ethmoid, zygomatic,
General introduction and outline
11