An Examination of Posttraumatic, Postsurgical Orbital Deformities: Conclusions Drawn for Improvement of Primary Treatment

Abstract

Sir: The article entitled “An Examination of Posttraumatic, Postsurgical Orbital Deformities: Conclusions Drawn for Improvement of Primary Treatment” by Wolfe et al. (Plast Reconstr Surg. 2008;122:1870–1881) was at once informative, interesting, and a pleasure to read. It was stated that the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier would improve the management of orbital injuries and prevent postsurgical orbital deformities. We also think that the methods set by Tessier constitute the mainstay of the management of craniofacial fractures and deformities. We have offered mild criticism regarding some of the topics. At first, according to us, routine usage of a coronal incision might cause some problems such as visible scars and partial alopecia at the frontotemporal region. We often use subtarsal or subciliary incisions for orbital fractures. While we are using a subciliary approach, we deepithelialize the lateral part of the flap and fix it to the bone periosteum to prevent ectropion to establish the tight structural support. As a result, the frequency of eyelid retraction would be diminished. In addition, we do not use the transconjunctival approach, because it would easily interfere with the inferior retractor mechanism of the lower eyelid. In case of reconstruction of the orbital floor with autogenous grafts and alloplastic materials, the authors should make a contribution about the infection and resorption rate of bone grafts. We agree that alloplastic materials provide us no benefit, as their complications would be more hazardous. Recently, we have used resorbable mesh plates and acellular dermal matrix grafts, and our results have been satisfactory so far. We would like to express our thanks to the authors for this valuable article reporting a greater than 30-year experience in the management of orbital fractures. Serdar Altun, M.D. Burak Alhan, M.D. Emre İnözü, M.D. Enver Arpacı, M.D. Ramazan E. Ünlü, M.D. Second Department Plastic and Reconstructive Surgery Ankara Numune Training and Research Hospital Ankara, Turkey