Late posttraumatic enophthalmos corrected by dense hydroxylapatite blocks

Abstract

Late enophthalmos caused by an unrepaired zygomatic or orbital blowout fracture can cause esthetic and functional impairment. The sunken appearance of the superior suicus and the depressed globe are obvious cosmetic defects. Functional impairment of the eye can also be troublesome, with restriction of motion and diplopia being common complaints. Early repair of surgically correctable fractures, prior to scar contraction or fat atrophy, is the most acceptable procedure. Even so, early repair is at times fraught with uncertainty, since the only parameter for measuring the adequacy of treatment is the late cosmetic and acceptable functional result. The various materials that have been used to treat orbital floor complications in the nonseeing eye include glass beads,’ tantalum,2 Teflon,3 polyethylene,4 polymethylmethacrylate,5 and Silastic6 In the seeing eye the placement of Silastic, cartilage,7 fascia,8 and bone,9,10 as well as osteotomy” have been used. Both the use of autogenous materials that resorb or move and osteotomy constitute only crude nonreproducible methods for the correction of late enophthalmos. This case report describes the use of hydroxylapatite in dense block form (Calcitek, San Diego, California) to correct late posttraumatic enophthalmos in a seeing eye.