Isolated Medial Orbital Wall Fracture Correction with Revision of Levator Plication - A Case Report

Abstract

The Rationale: Treatment options for isolated medial orbital wall fractures (IMOWF) vary. In young and favourable situations, most of the times, the fracture is left to heal spontaneously. If not properly monitored, it may improperly fuse causing poor form and function. Patient Concerns: A 24-year-old male presented for correction of his sunken left eye. The patient had a blunt trauma 10 years back and had left upper eyelid as well as ptosis correction elsewhere. Since that surgery, the patient noticed that the eye had been slowly and progressively “sinking” with time. Diagnosis: An IMOWF with periorbital fat entrapment and detachment of levator palpebrae superioris was identified. Treatment and Outcome: The fracture site was reached via a transcaruncular approach, the fracture corrected and orbital defect corrected with a mesh. One week later, in a second-stage surgery, under local anaesthesia, the muscle was repositioned. Recovery was uneventful and the desired aesthetic-functional results were achieved. Take-Away Lessons: An untreated IMOWF in young adolescents could persist and subsequent growth could amplify the enophthalmos. A careful diagnosis and treatment is warranted.