Orbital Trauma

Review the anatomy of the orbit. Does the nasal bone contribute to the orbit?  What are the seven bones of the orbit?

Define enophthalmos, hypophthalmos, telecanthus, hypertelorism.

Discuss the medial and lateral canthal tendon anatomy.

What should you look for on physical exam and how do you evaluate visual function?

Discern between a pure and impure orbital blowout fracture. What is the mechanism of a blowout fracture? What is a blow-in fracture? White-eye blowout fracture?

What is superior orbital fissure syndrome? Orbital apex syndrome? Discuss management of each.

Etiology and management of (non-surgical and surgical) traumatic optic neuropathy.

What is an afferent pupillary defect or Marcus Gunn pupil (provide us with a diagram of cranial nerve anatomy)?

Describe the subtarsal vs. subciliary vs. transconjunctival approach to orbital fractures. What are the pros and cons of each approach?

Reference(s):

Haeck, P. C. (2009, October). Improving the evaluation and management of the ambulatory and office-based surgical patient. Plastic and Reconstructive Surgery. United States.

Kothari, N. A., Avashia, Y. J., Lemelman, B. T., Mir, H. S., & Thaller, S. R. (2012). Incisions for orbital floor exploration. The Journal of Craniofacial Surgery, 23(7 Suppl 1), 1985–1989.

Principles of enophthalmos correction after orbital blowout. Does it correct diplopia?

Your chairman is brought to the emergency department after being struck in the face with a golf ball. CT scan of the face shows an orbital blow-out fracture. How would you evaluate and treat this injury? Discuss indications for repair.

Reference(s):

Winters, R., Chastant, R., & Graham, H. D. 3rd. (2014). When is immediate surgical intervention required for isolated orbital blowout fractures? The Laryngoscope, 124(3), 585–586.

Aldekhayel, S., Aljaaly, H., Fouda-Neel, O., Shararah, A.-W., Zaid, W. S., & Gilardino, M. (2014). Evolving trends in the management of orbital floor fractures. The Journal of Craniofacial Surgery, 25(1), 258–261.

Unfortunately, your chairman will need surgery and wants to know which biomaterial will be used to repair the floor defect? Show off your fund of knowledge and provide information on the choices. How will you decide which to use?

Reference(s):

Gunarajah, D. R., & Samman, N. (2013). Biomaterials for repair of orbital floor blowout fractures: a systematic review. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 71(3), 550–570.

Lim, T. C., Rasheed, Z. M., & Sundar, G. (2012). A safe and accurate method of assessing the size of implants required in orbital floor reconstruction. Craniomaxillofacial Trauma & Reconstruction, 5(2), 111–114.

Describe all the potential risks and complications in the repair of orbital floor fractures.

Reference(s):

Harris, G. J. (2014). Avoiding complications in the repair of orbital floor fractures. JAMA Facial Plastic Surgery, 16(4), 290–295.

Post-operatively, your chairman complains of persistent diplopia.

Reference(s):

Balaji, S. M. (2013). Residual diplopia in treated orbital bone fractures. Annals of Maxillofacial Surgery, 3(1), 40–45.

When would you consider an endoscopic approach to the repair of an orbital floor fracture?

Find a local law firm that will represent your colleagues when the chairman sues them for his diplopia.

Reference(s):

Svider, P. F., Kovalerchik, O., Mauro, A. C., Baredes, S., & Eloy, J. A. (2013). Legal liability in iatrogenic orbital injury. The Laryngoscope, 123(9), 2099–2103.