Reconstruction of the orbital wall using superior orbital rim osteotomy in a patient with a superior orbital wall fracture

Jae Jin Heo,Jeong Joon Han,Seunggon Jung,Min-Suk Kook,Hong-Ju Park,Hee-Kyun Oh,Ji-Hun Chong

doi:10.1186/s40902-018-0181-1

Jae Jin Heo, Jeong Joon Han + Show 5 more

Open Access

https://doi.org/10.1186/s40902-018-0181-1

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Abstract

BackgroundFractures of the orbital wall are mainly caused by traffic accidents, assaults, and falls and generally occur in men aged between 20 and 40 years. Complications that may occur after an orbital fracture include diplopia and decreased visual acuity due to changes in orbital volume, ocular depression due to changes in orbital floor height, and exophthalmos. If surgery is delayed too long, tissue adhesion will occur, making it difficult to improve ophthalmologic symptoms. Thus, early diagnosis and treatment are important. Fractures of the superior orbital wall are often accompanied by skull fractures. Most of these patients are unable to perform an early ocular evaluation due to neurosurgery and treatment. These patients are more likely to show tissue adhesion, making it difficult to properly dissect the tissue for wall reconstruction during surgery.Case presentationThis report details a case of superior orbital wall reconstruction using superior orbital rim osteotomy in a patient with a superior orbital wall fracture involving severe tissue adhesion. Three months after reconstruction, there were no significant complications.ConclusionIn a patient with a superior orbital wall fracture, our procedure is helpful in securing the visual field and in delamination of the surrounding tissue.

Highlights

Fractures of the orbital wall are mainly caused by traffic accidents, assaults, and falls and generally occur in men aged between 20 and 40 years
Fractures of the superior orbital wall are relatively rare compared to other facial fractures, and traffic accidents, assault, and falls have been reported as the main causes of such fractures [1,2,3,4]
Though the management of an orbital superior wall fracture is usually performed without surgical treatment in cases with minimal displacement of the fracture fragment, early surgical reconstruction is necessary if the displacement of the fracture fragment is severe and ophthalmologic or neurological symptoms appear [5, 6]

Summary

Background

Fractures of the superior orbital wall are relatively rare compared to other facial fractures, and traffic accidents, assault, and falls have been reported as the main causes of such fractures [1,2,3,4]. Patients who undergo delayed surgery due to neurosurgical treatment develop tissue adhesion, making it difficult to properly dissect the tissue for the reconstruction of the orbital wall during surgery. This case demonstrates a successful orbital reconstruction through a superior orbital rim osteotomy in a patient with severe tissue adhesions and is reported along with a review of the literature. After the adhered tissue was dissected, the superior orbital wall was reconstructed with a pre-prepared titanium mesh, and the superior orbital rim bone fragment was placed in the original position with a miniplate (Fig. 4c). At 3 months after surgery, further improvements in diplopia and exophthalmos with no limitation of ocular motility were found (Fig. 2b, d)

Discussion

Conclusions