Orbital Fracture Repair

Introduction

Surgical restoration of the orbital rim based on the eye (orbit) is a surgical procedure in which repair of the bony rim surrounding the eye (orbit) is done. Orbit plays a protective function for the eye and controls the corneal gaze position and ocular functions. Orbital fractures are primarily due to traumata such as accidents, falls, sports injuries and assaults on others. These can result in serious complications, including visual impairment, strabismus, and cosmetic deformities, when left untreated. The objective of surgical treatment is to achieve an improvement in both the peripheral and inner quality of life of the patient by restoring the orbital anatomy and physiology.

Timely diagnosis and treatment are essential for optimal recovery. Clinical management of orbital fracture repair, therefore, is a technical skill that demands a high skill level in ocular and maxillofacial surgery.

What is Orbital Fracture Repair?

Orbital fracture repair is restorable of other rbital rim bone in the body and as a consequence, can restore the orbit’s contour and function. The procedure focuses on repositioning bone fragments, removing bone fragments, and restoring the damaged structure using grafts and implant materials, respectively. The purpose of the surgery is to alleviate symptoms, regain vision, maintain complications, and enhance the aesthetic of the face.

Orbital fractures are classified by subtypes, including blowout fractures, orbital rim fractures and composite fractures. Treatment plans differ based on the severity and site of injury and accompanying symptoms.

Why is Orbital Fracture Repair Needed?

Repair of orbital fracture is indicated in patients with the following:

• Double Vision: Cutaneous and proprietary muscle misposition/impaired/trapped tissues may cause chronic diplopia (double vision).
• Enophthalmos: Subnormal appearance of the periorbital area because of bone displacement or vanishing of the orbital space.
• Vision Loss: Intraocular pressure resulting from the nerve of the optic and/or physiological misalignment of the eye can influence vision.
• Cosmetic Deformity: Visible asymmetry or structural damage to the orbital area.
• Orbital Hemorrhage: Intraocular fluid balling, associated with pain and orbital hypertension secondary to OC expansion.
• Restricted Eye Movement: Muscle entrapment or scarring can limit eye mobility.

Early, proactive operative intervention is in the patient’s best interest in avoiding late complications and saving the patient’s sight, mood, and movement.

Types of Orbital Fractures

Blowout Fracture:

• Infection is caused by direct trauma that arises in the floor or walls of the orbit.
• Commonly associated with sports injuries or blunt-force trauma.

Orbital Rim Fracture:

• Involves the outer edges of the orbit.
• Very common as a consequence of blunt force trauma, e.g., motor vehicle crash.

Combined Fracture:

• It affects both the orbital rim and the orbital floor.
• Requires more extensive surgical intervention.

Medial Wall Fracture:

• A small bone through which the orbit is separated from the nasal cavity.
• Ne, die durch die orbit unberührt als die paranasale Sinusterrhine unberührt bleiben.

Procedure Steps

1. Pre-Surgery Evaluation

The surgical process begins with a thorough evaluation.

• Imaging Tests: Doctors use CT, X-ray, and MRI to assess fracture load, size, and identify associated injuries like muscle entrapment or nerve invasion.
• Symptom Analysis: The surgeon evaluates vision, ocular derotation, and edema to determine if surgery is necessary.
• Treatment Planning: The surgical approach is customized based on the type and extent of the fracture.

2. Anesthesia

• Surgeons extensively apply general anesthesia to ensure patient comfort and safety in the operating room.

3. Surgical Access and Incisions

• Surgeons most often make incisions inside the eyelid (transconjunctival) or along the natural crease of the lower eyelid to reduce scarring.
• In some cases, a skin incision is required at or above the eyebrow and scalp to provide adequate access.

4. Bone Repair

• The incision on the mobile bone is made and the fracture is repaired with titanium plate repair, a screw, and a net mesh prosthesis.
• Graft materials of the patient’s own body or artificial materials are used to restore the orbital geometry.

5. Debris Removal

• Bone debris or scar tissue is harvested as well in a clean fashion, without any unnecessary trauma, to support the intended healing process.

6. Closure and Dressing

• Closed with an absorbable suture and with a sterile dressing covering the surgical wound, sutured incisional displacements.

Benefits of Orbital Fracture Repair

• Restores Vision: Corrects double vision and prevents optic nerve damage.
• Improves Appearance: Reconstructs the orbital structure for a symmetrical look.
• Prevents Long-Term Complications: Decreases (risk of) irreversible eye injury and chronic pain.
• Relieves Discomfort: Alleviates swelling, pressure, and restricted eye movement.
• Boosts Confidence: Restores facial symmetry and enhances self-esteem.

Cost of Orbital Fracture Repair

• United States: $10,000 – $25,000 
• United Kingdom: $8,000 – $20,000 
• Thailand: $4,000 – $8,000 
• India: $2,500 – $6,000 

Best Hospitals in India for Treatment

India has a reputation for having state-of-the-art facilities and top-notch orbital fracture surgeons. Notable hospitals include:

Metro Hospital Faridabad: Metro Hospital Faridabad:

• Renowned for advanced maxillofacial and ophthalmic surgical care.
• Equipped with cutting-edge technology for facial trauma management.

Max Healthcare (Delhi): Max Healthcare (Delhi)

• Provides state-of-the-art facilities and an expert team of specialists.

Fortis Healthcare (Delhi): Fortis Healthcare (Delhi)

• General acclamation for a treatment option for orbital fractures such that the rates of optimal success are high.

Risks and Complications

Repair of orbital fracture is, however, typically a safe procedure but there may be:

• Infection: Rare but preventable with proper aftercare.
• Scarring: Minimal due to strategically placed incisions.
• Persistent Double Vision: Temporary or, in rare cases, permanent.
• Nerve Damage: Temporary numbness in the treated area may occur.
• Implant Issues: Complications with grafts or implants are uncommon but possible.

Recovery

Immediate Recovery

• First Week: Swelling and bruising around the eyes are normal. Pain medications and cold compresses help manage discomfort.
• Activity Restrictions: Patients should abstain from all strenuous activity, heavy lifting and ocular contact.

Long-Term Recovery

• 2-4 Weeks: Swelling resolution is not uncommon and patients can return to their normal activity per day.
• 6-12 Weeks: Restoration is obtained through better vision and esthetics, which are both proven.
• Follow-Up Care: Follow-up is also of great importance for postoperative healing and postoperative complications management.