Orbital Blowout Fracture Repair Research Articles

Systemic Outcomes in Adults Undergoing Emergent Repair of Orbital Blowout Fractures

Systemic Outcomes in Adults Undergoing Emergent Repair of Orbital Blowout Fractures

Automatic Identification and Segmentation of Orbital Blowout Fractures Based on Artificial Intelligence.

The incidence of orbital blowout fractures (OBFs) is gradually increasing due to traffic accidents, sports injuries, and ocular trauma. Orbital computed tomography (CT) is crucial for accurate clinical diagnosis. In this study, we built an artificial intelligence (AI) system based on two available deep learning networks (DenseNet-169 and UNet) for fracture identification, fracture side distinguishment, and fracture area segmentation. We established a database of orbital CT images and manually annotated the fracture areas. DenseNet-169 was trained and evaluated on the identification of CT images with OBFs. We also trained and evaluated DenseNet-169 and UNet for fracture side distinguishment and fracture area segmentation. We used cross-validation to evaluate the performance of the AI algorithm after training. For fracture identification, DenseNet-169 achieved an area under the receiver operating characteristic curve (AUC) of 0.9920 ± 0.0021, with an accuracy, sensitivity, and specificity of 0.9693 ± 0.0028, 0.9717 ± 0.0143, and 0.9596 ± 0.0330, respectively. DenseNet-169 realized the distinguishment of the fracture side with accuracy, sensitivity, specificity, and AUC of 0.9859 ± 0.0059, 0.9743 ± 0.0101, 0.9980 ± 0.0041, and 0.9923 ± 0.0008, respectively. The intersection over union (IoU) and Dice coefficient of UNet for fracture area segmentation were 0.8180 ± 0.0093 and 0.8849 ± 0.0090, respectively, showing a high agreement with manual segmentation. The trained AI system could realize the automatic identification and segmentation of OBFs, which might be a new tool for smart diagnoses and improved efficiencies of three-dimensional (3D) printing-assisted surgical repair of OBFs. Our AI system, based on two available deep learning network models, could help in precise diagnoses and accurate surgical repairs.

Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction

ABSTRACT Purpose To compare the outcome of orbital blowout fracture repair by means of pre-formed porous-polyethylene titanium implants (PFI) vs patient-specific porous-polyethylene implants (PSI). Methods Retrospective cohort study. Baseline characteristics, ophthalmic examination results, ocular motility, fracture type, the timing of surgery, implant type, and final relative enophthalmos of all patients operated on for blow-out fractures in a single center were collected and analyzed. Results Twenty-seven patients (mean age 39 years, 9 females) were enrolled. Sixteen underwent fracture repair with PFI and 11 with PSI at 11 months (median) post-trauma. Mean follow-up duration was 1.1 years. Both groups showed significant postoperative improvement in primary or vertical gaze diplopia (P = .03, χ2). Relative enophthalmos improved from −3.2 preoperative PFI to −1.7 mm postoperative PFI, and from −3.0 mm preoperative PSI to −1.1 mm postoperative PSI (P= .1). PSI patients had non-significantly less postoperative enophthalmos and globe asymmetry than PFI patients. The outcome was not influenced by previous surgery, age, sex, number of orbital walls involved in the initial trauma, or medial wall involvement (linear regression). Both groups sustained complications unrelated to implant choice. Conclusion Both PSI and PFI yielded good outcomes in this study. PSI may be a good alternative to PFI in primary or secondary orbital blowout fracture repair with less enophthalmos and globe asymmetry, in spite of the possible disadvantages of production time, a relatively larger design, and challenging insertion. Since it is a mirror image of the uninjured orbit, it may be beneficial in extensive fractures.

Orbital Apex Syndrome and Central Retinal Vein Occlusion after Blow-out Fracture Repair

Purpose: To report a case of orbital apex syndrome and central retinal vein occlusion after blow-out fracture repair.Case summary: A 22-year-old man who underwent emergency re-operation in a department of plastic surgery due to pain, decreased visual acuity, and ophthalmoplegia in all direction after orbital blow-out fracture repair was referred to ophthalmologist on postoperative day 2 and there was no improvement in symptoms. He showed severe complications, including optic neuropathy and ophthalmoplegia in all direction, central retinal vein occlusion, and outer retinal disruption caused by orbital apex hemorrhage. Although we were concerned that it was too late, we started high dose steroid intravenous pulse treatment and the visual acuity, ophthalmoplegia, and retinal findings were improved. However, the optic atrophy and visual field defect did not.Conclusions: After a complicated blow-out fracture repair in other department, if a patient shows severely decreased visual acuity or ocular movement limitation, a thorough and immediate ophthalmologic examination is recommended. During ophthalmologic examination, meticulous examination of the entire eye, including the retina, is required, in addition to general orbital complications. A relatively good prognosis can be expected through accurate cause analysis and appropriate treatment for the confirmed abnormal findings.

Surgical Repair of Orbital Blow-Out Fractures: Outcomes and Complications.

Objectives:The purpose of this study is to evaluate the demographics of patients with orbital blow-out fractures, as well as the success and complications of surgical repair with porous polyethylene membrane sheet implants through transconjunctival technique and to compare the results to previously published studies.Methods:This retrospective study included 57 patients diagnosed with orbital blow-out fractures referred to our clinic between 2018 and 2022. Seventeen patients (29.8%) underwent orbital fracture repair through a transconjunctival technique employing porous polyethylene membrane sheets. The indications for surgery were enophthalmos >2 mm and persistent ocular motility restriction, diplopia, and strabismus. The success criteria were <2 mm of enophthalmos and complete correction of eye motility, diplopia, and strabismus.Results:The study group consisted of ten females and 47 males with a mean age of 31.12 years. The most common cause of injury was assaults (50.9%), followed by falls (38.6%), traffic accidents (5.3%), and accidental impacts (5.3%). The inferior wall (61.4%) was the most common fracture site, followed by the medial wall (21.1%) and a combination of the inferior and medial walls (21.1%). The surgically treated group showed a significant improvement in ocular motility restriction (88.2–23.5%, p=0.002), diplopia (70.6–23.5%, p=0.008), and enophthalmos (1.41 mm to 0.82 mm, p=0.012) after surgery. The surgery was successful in ten of 17 cases (58.8%), and the success rate was higher in patients who were treated early (77.8% vs. 37.5%), but the difference was not statistically significant (p=0.092).Conclusion:Orbital blow-out fracture repair using porous polyethylene membrane sheets through a transconjunctival approach is a safe and effective surgical technique for orbital blow-out fracture repair. Although patients who had early surgery had a higher success rate in our study group, larger study groups are needed to assess the effect of surgical timing on success.

STRABISMUS MANAGEMENT AFTER ORBITAL BLOWOUT FRACTURE

Orbital floor fractures (OBF) account for 40% of mid-facial injuries and are therefore the most common of all trauma injuries in this region. The post-treatment complication that often follows orbital floor repair is residual diplopia or 1 persistent diplopia and is seen in 86% of the OBF cases. The causes for persistent diplopia can be varied and is often related to the degree of inflammation, trauma to 2 musculature, fat or nerves and surgical timing. Some of the common causes of the same are - malpositioning of the globe, fibrosis of the inferior fibro fatty muscular complex following trauma, direct damage to an extraocular muscle (commonly inferior rectus muscle), local injury to a motor nerve, ischemia (or compartment syndrome), iatrogenic damage during reconstructive surgery or entrapment under improperly placed alloplastic material. Our case report mentions a rare case of persistent vertical diplopia even after successful repair of orbital blowout fracture. A 15-year-old male patient following a road traffic accident presented with persistent headache and vertical diplopia. The patient was evaluated by a oral maxillofacial surgeon and a presumptive diagnosis of a case of large orbital floor fracture with entrapment of inferior rectus muscle was made which was confirmed on CT Scan. He was managed surgically by reduction of the fracture and fixation with a titanium mesh. 2 weeks post-surgery he reported to the squint clinic with complaints of persistent double vision. On comprehensive ocular examination, it was found that patient had vertical diplopia with limitation of infraduction in the left eye with negative FDT, on re-evaluation of MRI scans with 1 mm cuts, a partial left inferior rectus tear was seen and documented as the cause of persistent diplopia. Patient was treated conservatively by prescribing prismatic glasses with fusional exercises. After 6 months of follow up, the patient was relieved of diplopia in primary position but there was a residual hypotropia in downgaze for which he was prescribed prisms only for downgaze.

Comparison of Nasoseptal Cartilage Graft Versus Titanium Mesh in Reconstruction of Pure Orbital Blowout Fractures.

To compare the efficacy of nasoseptal cartilage grafts versus titanium mesh implants in pure orbital blowout fractures. A retrospective review was performed on 48 patients who had surgical repair of an orbital fracture. Patients who underwent pure orbital blowout fracture repair with either nasoseptal cartilage grafts or titanium mesh implants and at least 1 year postoperative follow-up were included in the study. The clinical features and treatment outcomes were analyzed. Twenty-five patients fulfilled our study criteria and were included in the analyses. Nasoseptal graft was used in 12 patients (48%) while titanium mesh was preferred in 13 patients (52%). Preoperative clinical features including age, size of the floor defect, and preoperative clinical findings (enophthalmos, diplopia, and restriction of ocular motility) were similar between 2 groups. Mean postoperative follow-up was 14.7 ± 2.3 months in the nasoseptal group while it was 16.1 ± 2.5 months in the titanium group (P = 0.84). Diplopia and ocular motility limitation were resolved in all patients at the last postoperative follow-up visit, while 1 patient in each group had enophthalmos (8.3% versus 7.6%, P = 1.0). No patient in the nasoseptal group experienced postoperative complications while 2 patients in the titanium group (15.3%) developed material-related complications (P = 0.48). Long-term clinical results of nasoseptal cartilage grafts and titanium mesh implants in pure orbital blowout fractures with preoperative floor defects smaller than 4 cm2 were comparable. Nasoseptal cartilage grafts may be preferred in patients with septal deviation and no spurs or turbinate hypertrophy.

Quantitative Assessment of the Pupil: An Underrecognized Yet Important Factor Related to Orbital Blowout Fracture Repair.

To investigate dynamic pupil changes after orbital blowout fracture repair. To compare postoperative changes in under photopic and mesopic pupil size and center position after orbital blowout fracture repair surgery. The study evaluated 19 eyes. Pupils were imaged for pupil size and center position before and 3 months after orbital blowout fracture repair surgery. Pupil size changes were measured, and the correlation between preoperative and postoperative pupil centroid shift was evaluated. After repair, operative eyes exhibited a growth of 9.3% ± 8.6% in pupil size, and contralateral eyes showed a growth of 8.6% ± 8.2% (P = 0.011, P = 0.007). Similar findings were noted in mesopic conditions. Under mesopic conditions, the pupil of operative eyes in medial orbital wall fracture deviated 0.030 ± 0.019 mm towards the nasal side along the X-axis (P = 0.031). The postoperative orbital floor fracture group demonstrated statistical significance at a spatial frequency of 5 (P = 0.041). Orbital blowout fracture repair surgery affects pupil size and center position.

The Utility of Postoperative Computed Tomography Imaging Following Isolated Orbital Blowout Fracture Repair.

To determine the clinical utility of computed tomography (CT) imaging following isolated orbital blowout fracture (OBF) repair. Single-center retrospective review of adult patients undergoing surgical repair of isolated OBFs between November 2008 and August 2016 who received postoperative CT scans. Preoperative and postoperative examination data, postoperative imaging reads, postoperative courses, and any reoperation documentation were collected from electronic medical records. Postoperative imaging findings were categorized as major, indeterminate, or minor by predicted impact on clinical management. Major findings indicated a need for reoperation, indeterminate a potential reoperation, and minor no reoperation. Fifty-two cases met inclusion criteria: 94.2% (n = 49) of postoperative scans included minor findings, 34.6% (n = 18) indeterminate findings, and 19.2% (n = 10) major findings. Three patients returned to the operating room (OR) for surgical revision. All 3 had a significant and concerning change on postoperative examination. Only 1 also had a major finding on postoperative imaging. The remaining 49 patients had benign postoperative examinations, despite 9 (17.3%) with major imaging findings who did not undergo reoperation. In the majority of OBF repairs, postoperative CT scan findings were not predictive of a need to return to the OR for revision. Reoperation was instead largely prompted by concerning changes in the postoperative clinical examination. Our findings suggest that postoperative imaging in the absence of clinical concern should not be included in the surgical management of isolated OBFs. Instead, targeted imaging will help reduce radiation exposure and health-care costs without sacrificing patient care.

Transnasal endoscopic repair of orbital blowout fracture: case report

A blowout fracture is a fracture of the walls or floor of the orbit, due to blunt orbital trauma. Management is conservative or surgical when indicated, and classical external approaches are subciliary, transconjunctival, and subtarsal. We report a case of orbital blowout fracture, presented with vertical diplopia and managed successfully by transnasal endoscopic approach. This approach is very promising for the management of blowout fracture with ocular movement limitation owing to trapped muscles or fascia. It is minimally invasive, avoids surgical scars and eye traction, and shortens operative time. The limitation is it gives no access to lateral wall fractures.

Advances in the research and application of orbital blowout fracture repair material

Orbital blowout fractures can easily lead to defects of the orbital wall. In order to restore the continuity of the bone wall and avoid a series of clinical symptoms caused by orbital contents herniation or incarceration, the site of the defect should be reconstructed. The effect of reconstruction depends on the choice of surgical plan and repair material. The typical materials for bone wall defect repair include bone sheet, high density porous polyethylene, titanium mesh, absorbable polymer, bioactive ceramics and tissue engineering bone. This paper reviews the research findings and application of material for repairing of orbital blowout fracture. (Chin J Ophthalmol, 2019, 55: 876-880).

Outpatient Surgical Management of Orbital Blowout Fractures.

There is ample investigation into the optimal timing and approach to orbital blowout fracture (OBF) repair; however, less attention has been directed toward postoperative care. This is a multicenter IRB-approved retrospective review of patients with OBF presenting to our study sites between November 2008 and August 2016. Those with isolated OBF, over 18 years of age, and who had not suffered additional facial injuries or globe trauma were included. A total of 126 surgical cases of isolated OBF repair were identified that met our inclusion and exclusion criteria; 42.1% were outpatient repairs while the remaining 57.9% were admitted for overnight monitoring. Time elapsed prior to repair differed between the two groups at a mean of 8.4 days versus 5.2 days for the outpatient and inpatient cohorts, respectively ( p = 0.001). A majority of inpatient cases underwent immediate repair, while a majority of outpatient cases were delayed. There were two cases of RBH in the outpatient cohort resulting in an overall incidence of 1.6%. In both instances, a significant change in clinical exam including decreased visual acuity, diplopia, and eye pain prompted repeat evaluation and immediate intervention for hematoma evacuation. Estimated hospital charges to the patient's insurance for key components of an inpatient versus outpatient isolated OBF repair amounted to a total cost of $9,598.22 for inpatient management and $7,265.02 for outpatient management without reflexive postoperative imaging. Reflexive postoperative CT scans were obtained in 76.7% of inpatient cases and only two led to a reoperation. No outpatient repairs included reflexive postoperative imaging. Outpatient OBF repair is an attractive alternative to inpatient management. The potential cost savings of outpatient management of OBF, which do not detract from quality or safety of patient care, should not be ignored. Our results will hopefully contribute to updated shared practice patterns for all subspecialties that participate in the surgical management of OBF.

Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction.

The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.

Choroidal volume changes following blow-out fracture repair.

To investigate the serial choroidal volume change following orbital blow-out fracture (BOF) repair. The choroidal volume was measured by optical coherence tomography in patients who underwent BOF repair, preoperatively and postoperatively at 1, 4, 12 and 24weeks. The orbital volume ratio (OVR) was obtained by dividing the orbital volume of the traumatized orbit by that of the contralateral side using three-dimensional computed tomography imaging. The choroidal volume change was compared between both eyes using a linear mixed model. We analyzed the choroidal volume of 11 patients. Choroidal volume showed a trend of slight increase during the immediate postoperative period, and then, choroidal volume decreased abruptly between postoperative 1 to 4weeks (β-coefficient - 0.22, P < 0.001). Choroidal volume also showed gradual decrease between postoperative 4 to 24weeks (β-coefficient - 0.02, P < 0.001). During the study period, there were no significant differences in choroidal volume change between BOF and contralateral unaffected eyes (β-coefficient - 0.20, P = 0.711). The hyperopic refractive errors (β-coefficient 0.27, P = 0.028) and the larger preoperative OVR (β-coefficient 10.37, P = 0.013) were associated with larger choroidal volume. Choroidal volume showed a similar decreasing change following BOF repair between the BOF and the contralateral unaffected eyes. Moreover, choroidal volume of both eyes was associated with the degree of orbital volume expansion due to BOF, suggesting that choroidal volume change after BOF repair was affected not only by trauma-associated local hemodynamic changes but also by systemic influences such as inflammatory response.

Efficacy of endoscopic transantral versus transorbital surgical approaches in the repair of orbital blowout fractures: study protocol for a randomized controlled trial

Background: Repair of orbital blowout fractures faces a lot of complications and difficulties to restore and reconstruct the exact position of the orbital bony skeleton especially at the orbital rims, and also a difficulty in restoring the functions of the orbital soft contents such as the muscles, the globe and the lacrimal system. Methods/Design: This prospective randomized controlled trial with a two-arm, parallel-group structure evaluating the efficacy of endoscopic transantral surgical versus traditional transorbital surgical approaches in the treatment of orbital blowout fractures will be conducted at Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt. Thirty-eight patients with diplopia due to orbital blowout fracture will be recruited. All patients will undergo CT, pulse test, and forced duction test. The primary outcome measure is the diplopia resolution detected intraoperatively via forced duction test. The secondary outcomes include the enophthalmos correction, preservation of orbital floor periosteum and exacting/equalization of the injured bony level on the non-injured side. Discussion: The results of the trial will support better decision-making for surgical treatment in orbital blowout fractures. Trial registration: ClinicalTrials.gov identifier: NCT03011047 registered on January 4, 2017. Ethics: This protocol and the template informed consent form was approved by the Ethics Committee of Scientific Research, Faculty of Oral and Dental Medicine, Cairo University, Egypt (February 2017). Informed consent: Written informed consent will be obtained from all participants prior to the trial.

A Case of Hemorrhagic Cyst Caused by a Silicone Implant Used for Orbital Blow-out Fracture Repair

A Case of Hemorrhagic Cyst Caused by a Silicone Implant Used for Orbital Blow-out Fracture Repair

眼窩底骨折手術に使用したシリコンプレートが原因で囊胞形成を認めた1例

眼窩底骨折手術に使用したシリコンプレートが原因で囊胞形成を認めた1例

Prognostic CT findings of diplopia after surgical repair of pure orbital blowout fracture.

Diplopia is a common sequela of blowout fracture even after proper surgical management. We investigated the prognostic factors of diplopia after surgery of pure blowout fracture. We retrospectively reviewed CT images of 181 patients with pure orbital blowout fracture who underwent at least six months of postoperative follow-up. We evaluated the following CT factors: (1) fracture site (orbital floor, medial wall of the orbit, or both), (2) fracture type (closed flap, open flap), (3) fracture size, (4) volume of herniated orbital soft tissue, (5) ratio of volume of herniated orbital soft tissue to fracture size, (6) number of points of contact between extraocular muscle (EOM) and bony edge, (7) presence of EOM thickening, (8) EOM swelling ratio, (9) presence of displacement of EOM, (10) presence of deformity of EOM, (11) presence of tenting of EOM, and (12) presence of entrapment of EOM. The associations between diplopia at six months after surgical repair and various risk factors were analyzed using logistic regression models for univariable and multivariable analyses. EOM tenting and deformity and ratio of volume of herniated orbital soft tissue to fracture size were found to be statistically significant risk factors of diplopia at six months after repair on univariable analysis (all P<0.05). Patients who showed EOM tenting or deformity on CT images had 5.22 and 10.85 times greater probability of diplopia after surgery, respectively (P-value, <0.001 and 0.026; 95% confidence interval of odds ratio, 2.071-13.174 and 1.323-88.915, respectively). On the other hand, ratio of volume of herniated orbital soft tissue to fracture size was not significant on multivariable analysis (P=0.472). The prognosis of patients was predicted by CT evaluation. Patients who have tenting or deformity of EOM on CT scan are more likely to have postoperative diplopia.

Outcomes of Orbital Blow-Out Fracture Repair Performed Beyond 6 Weeks After Injury.

Blow-out fractures cause expansion of the bony orbital walls and prolapse of orbital contents in the sinuses. This can result in diplopia, enophthalmos, and hypoglobus. Early surgical repair has been previously recommended, however, recent reports show that delayed surgery can also be effective. In this study, the clinical and functional outcome of patients with delayed presentation and blow-out fracture repair beyond 6 weeks after injury are described. This is a noncomparative retrospective study. Medical records of adult patients with late orbital floor fracture repair performed by 4 surgeons from April 2008 to January 2014 at 3 tertiary referral centers were reviewed. All repairs were performed more than 6 weeks from the time of injury. Patients with prior orbital fracture repair surgery were excluded. Twenty patients were included in the study. The duration from time of injury to surgery ranged from 7 weeks to 21 years with a mean of 19 months. Follow up ranged from 6 weeks to 56 months (mean 8 months). Mean age was 48 years (range, 25-80). Male to female ratio was 11:9. Surgery was performed on 10 right eyes and 10 left eyes. CT imaging demonstrated 10 patients had isolated floor fractures, while the remaining 10 patients had combined floor and medial wall fractures. Four patients also had associated facial fractures that did not require surgery. Indications for surgery included enophthalmos of 2 mm or more (18 of 20) and/or significant diplopia within 30° of primary gaze (6 of 20). Mean pre- and postoperative enophthalmos was 2.4 ± 0.9 mm and 0.3 ± 0.2 mm, respectively, corresponding to a mean reduction in enophthalmos of 2.1 ± 1.2 mm (range, 1-5 mm). Four of 7 patients with hypoglobus ranging from 1.5 mm to 8 mm preoperatively had complete resolution postoperatively, the remaining 3 patients showed reduced hypoglobus. Of the 12 patients that had diplopia preoperatively in any position of gaze, 6 patients had complete resolution of diplopia postoperatively, 4 patients had reduced but residual diplopia in extreme gaze, and 2 patients had persistent diplopia, in primary position and down gaze, respectively. Two patients had poor vision that precluded the manifestation of diplopia. None of the 6 patients without preoperative diplopia developed symptoms post operatively. Surgical repair of blow-out fractures of the orbit occurring more than 6 weeks or more from injury can achieve marked improvement in both the functional and cosmetic aspects. The likelihood of induced diplopia is low. Orbital floor fracture repair should be considered to successfully treat enophthalmos or diplopia in patients with delayed clinical presentation, even decades postinjury.

Analysis of complications after orbital reconstruction with Medpor implantation for the orbital blowout fracture

Objective To analyze the causes of complications after orbital reconstruction with high density porous polyethylene (Medpor) for the repair of orbital blowout fracture. Methods A retrospective analysis of patients with orbital blowout fracture treated with Medpor in our department was carried out. Results In 232 cases after postoperative follow up of 3 months, the visual function decreased significantly in 2 cases, endophthalmos was undercorrection in 7 cases, residual diplopia was observed in 2 cases and implant displacement was detected in 1 case. Conclusion There are many kinds of complications after orbital reconstruction with Medpor implantation for blow-out fracture of orbital floor wall, such as vision loss, enophthalmos, diplopia exacerbation, infection, and so on. The causes are related to the degrees of fracture, location, doctor's skill and experience, and postoperative functional training. The key points for successful repair of orbital fracture include effective prevention, correct analysis of causes and timely treatment. Key words: Blowout fracture, orbital; Medpor; Surgery, reconstrution; Effect, undesirable