Implant alternatives and the treatment of enophthalmos and motility problems after orbital fractures

Abstract

Combined orbital fractures cause hematomas and subsequent stiffness of the ligament apparatus around the inferior rectus muscles, while the few true blow-out-fractures may lead to adhesions of the connective tissue to the floor. We describe a third mechanism: Enlargement of the orbit impairs the motility, especially the elevation of the globe: Diagnostic indentation of the orbital, parabulbar contents improves the elevation. In nine such cases without the known two other mechanisms the authors could improve the motility by reducing the orbital volume. This was performed by implants (four cases), by instillation of hydroxylapatite (four cases) or by re-resection of the bony frame (one case). Subsequent muscle surgery, whenever still necessary, gave really sufficient results.