What is the orbit?
The orbit is the bony “box” or structure located on either side of the nose that surrounds and protects the eyes and the tissue around the eyes. Each orbit is a pear shaped structure, and is formed by seven different bones.
Trauma to the orbit or face, such as a car accident, sports injury, or blow to the face can cause an orbital or facial fracture, which can produce specific symptoms given the injury. The symptoms of an orbital fracture include swelling and bruising around the eye, double vision, decreased vision, decreased movement of the effected eye, numbness of the cheek, gums, and upper teeth, and the eye sinking back into the eye socket. Fractures of the face commonly occur simultaneously with an orbital fracture and can include flattening of the cheek with facial asymmetry and pain while chewing and misalignment of the teeth.
How are orbital and facial fractures diagnosed?
A person who sustains trauma to the orbit and face should have a complete eye examination by an ophthalmologist to rule out damage to the eye. After the initial eye examination, evaluation of the orbits and face is done to rule out a fracture. Most orbital fractures can be diagnosed by examination alone, however; when an orbital fracture is suspected, a CT scan is recommended. A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays and can directly show the size and location of an orbital or facial fracture. If a patient has already had a CT scan after an injury (usually performed in an emergency room), Dr. Lissauer will always want the patient to bring the films or computer disc to the initial examination.
How are orbital and facial fractures treated?
Once an orbital or facial fracture has been diagnosed, the indications for surgical repair must be established. If an orbital fracture is small with no symptoms, treatment is conservative with observation.
Indications for surgical repair of an orbital fracture are; double vision due to the eye muscles trapped within the broken bone fragments, sinking of the eye back into the head, or a large fracture seen on the CT scan. Large fractures have the potential for the eye sinking back into the head at a later date.
Indications for surgical repair of a facial fracture are significant displacement of the bones, flattening of the cheeks or pain when chewing.
How is an orbital or facial fracture surgically repaired?
If surgical repair of an orbital is required, current recommendations are to repair the orbital fracture within 14 days of the initial injury. Delaying surgery beyond this time can make the repair more difficult as the fracture and displaced tissue within the fracture site can start scarring into place.
Facial fractures are generally repaired within seven days if possible as delayed repair of a displaced facial fracture may result in new bone formation at the fracture sight, which would require re-breaking the bones to re-align the initial fracture.
Orbital fractures are repaired by making an incision on the inside of the eyelid (transconjunctival incision) with a small skin incision in the corner of the eyelid to gain access to the fracture site. Facial fractures are repaired making an incision on the inside of the mouth, or small incisions in the hairline. This allows for reconstruction of the fracture with almost no visible scarring.
Orbital fractures may require a synthetic implant. Different types of synthetic implants are used to repair orbital fractures, such as porous polyethylene – a porous high-density plastic, titanium plates, or a combination of the two. Implants are used to re-align the edges of the bones and keep the surrounding tissue from prolapsing (falling back) into the fractured areas. Whether or not an implant is required would be determined after a thorough examination and reviewing findings of a CT scan.
Facial fractures usually require titanium screws and plates to stabilize the bones in position once the fracture has been reduced or re-aligned. In a combined orbital and facial fracture, support can be required at different areas and will require multiple different types of implants.
In select cases, Dr. Lissauer performs the surgery with other reconstructive surgeons in a combined repair of the fracture. This provides a very specialized approach to repairing any facial and orbital fracture in one surgical procedure, reducing further surgeries and providing an optimal result.
How is orbital and facial fracture surgery performed?
Dr. Lissauer performs orbital and facial fracture surgery usually as an outpatient procedure at The Manhattan Eye, Ear and Throat Hospital in New York with general anesthesia administered by an anesthesiologist. Generally the procedure is about two to three hours depending on the extent of the fracture.
If you are scheduling a consultation for an orbital or facial fracture, please bring in any CT scans or MRI discs or images and reports to your appointment.
If you would like to schedule a consultation regarding an orbital or facial fracture please contact our New York office at: 212-717-2150 for an appointment.