Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert, Coauthors: Enno-Ludwig Barth, Harald Essig

Midface - Combined medial wall and orbital floor fractures

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Glossary

General considerations

This is the most frequent orbital wall fracture pattern leading to functional and aesthetic problems. The clinician should address the combined deformity. Anatomical plates facilitate the reconstruction of the defect.

The decision to perform open treatment or to observe is based on thorough clinical and radiographic (CT) evaluation.

Observation
Main indication Skill Equipment
Non- or minimally displaced fractures without orbital deformity and intact ocular motility. Basic surgical experience, no specialized skills Basic equipment only
Orbital reconstruction
Main indication Skill Equipment
Standard method of treatment for the repair of critical sized orbital wall defects. Some specialized surgical experience Simple surgical and imaging resources

Further indications

  • Significant internal orbital defects proven by imaging
  • Disturbances of eye mobility that are the result of incarceration of ocular muscles
  • Enophthalmos 
  • Exophthalmos secondary to blow-in fractures
  • Hypophthalmos

Contraindications

  • Severe ocular trauma such as a rupture of the globe, hyphema, retinal detachment, traumatic optic nerve lesions, or other severe globe injury may necessitate delay of orbital wall repair.
  • General patient condition not allowing surgery
  • Orbital fracture in the only seeing eye (relative contraindication)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2009-12-03