Management of simultaneous ocular elevation and depression deficit in patients after reconstruction surgery for orbital floor fracture

Abstract

Purpose To present and examine the results of surgical correction of simultaneous ocular elevation and depression deficit in patients who underwent reconstruction surgery for orbital floor fracture. Methods A retrospective analysis of medical records of patients who had undergone surgical correction for diplopia associated with orbital fracture which persisted after orbital reconstruction surgery. All patients underwent orthoptic evaluation before surgery and postoperatively with various times of follow-up. Results Eight cases of blow-out fracture of the orbital floor were identified. Surgical plan varied from case to case. It included thorough revision of inferior rectus/oblique complex with or without recession of the former or flap tear repair and additional procedures. Postoperatively 4 patients (50%) were diplopia free, 3 (37.5%) presented diplopia in extreme upgaze and 1 (12.5%) in mid-upgaze and adduction. None of the patients reported diplopia in the primary position neither downgaze. Conclusion Diplopia persisting after reconstructive surgery of a fractured orbital floor may be corrected surgically. Our results suggest that at least two surgical procedures are necessary to achieve satisfying outcomes. Contralateral inferior rectus recession combined with superior oblique recession and superior rectus posterior fixation appears to be effective procedures for use.

Modified Target Angle as a Predictor of Success in Strabismus Management after Orbital Fracture

“…(1) direct damage to the extraocular muscle by a traumatic event [36], (2) muscle ischemia from the intraorbital pressure [37], (3) iatrogenic muscle damage during the reconstruction surgery [38], (4) adhesion between the muscle and nearby soft tissue or reconstructive material [11], (5) fibrosis [39], (6) entrapment by reconstructive material placed during reconstruction surgery [38], and (7) a combination of one or more of the above mechanisms [7]. Hence, there are a variety of methods to correct strabismus in these patients to alleviate diplopia in certain gazes and broaden the BSV field [8,40]. However, no consensus has been reached in the management of strabismus in this patient group; often the decision is left to the surgeon's preferences.…”

Orbital Floor Reconstruction with Titanium Mesh: A 5-YearAudit of a Tertiary Care Hospital

“…Expelled/displaced orbital contents limit ocular motility and can induce diplopia. (6) Diplopia in orbital floor fractures is caused by a variety of factors, including complications of orbital volume disparity in enophthalmos, extraocular muscle and orbital fat tissue herniation, extraocular muscle injury, motor nerve injury, and extraocular muscle cicatricial contraction and adhesion formation (7). Extraocular muscle limitation is caused by all of these reasons.…”

“…To prevent herniation in the maxillary sinus/pterygopalatine fossa/medial wall, surgical intervention is required to push back displaced content and place adequate separating material (6).…”