Bilateral Orbital Fracture Repair
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This is a second case after repair of orbital fractures.
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In this case,
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one sees that the patient has had bilateral fractures of the orbital
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floor with their communication to the medial orbital wall.
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Once again,
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the approximation of the mesh to the orbital floor need not be exact.
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Sometimes, one can see the fracture repair extend
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upward along the medial orbital wall
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if the fracture has extended along the lamina papyracea,
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so these would be extending both to repair the orbital floor ,
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as well as the medial orbital wall in a continuous fashion.
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The main thing that you do want to see, with regard to the repair, is that
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the mesh that's laid in crosses the plane of the fracture itself.
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So, it goes across the entire extent of the fracture.
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Complications of the repair include continuous herniation
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of either fat or muscle through the orbital floor or medial orbital wall
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or orbital hematoma.
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Therefore, in addition to the bone windows,
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it's important to continue to look at the soft
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tissue windows and observe the absence of hemorrhage
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in the retrobulbar compartment or intraconal space,
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or extraconal space.
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In this case, the repair is outstanding.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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