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 - Orbital floor

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Glossary

General considerations

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
Open reduction with or without internal fixation
Main indication Skill Equipment
Indicated for the rare cases where the reduced fracture segment is stable. Some specialized surgical experience Simple surgical and imaging resources
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)
Orbital reconstruction, CAS: Intraoperative imaging
Main indication Skill Equipment
Ideal method for control of treatment for the repair of critical sized orbital fractures, when intraoperative imaging is available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Any orbital fracture benefits from intraoperative CT scanning to visualize adequacy of orbital wall reconstruction.

Orbital reconstruction, CAS: Virtual planning and intraoperative navigation
Main indication Skill Equipment
Ideal method for control of treatment for the repair of critical sized orbital fractures, when intraoperative navigation equipment is available. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Severe orbital fractures, especially those that involve more than one wall benefit from virtual planning and intraoperative navigation.

*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