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Orbital anatomy and trauma /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. ORBITAL FRACTURE INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTION  The importance of orbit is to protect vital structures by allowing fractures to occur. Because the globe is surrounded by fat and the medial wall and floor of the orbit are thin, force that is transmitted to the globe allows fracture of the orbit without significant globe injury. This accounts for the significantly higher incidence of fractures of the orbit as compared to open globe injuries. www.indiandentalacademy.com
  • 3. AIM    To manage trauma or any injury to the orbital region both functionally and esthetically. To correct diplopia and enopthalmos. To know proper anatomy so that structures related to this area can be restored back to there anatomical position. www.indiandentalacademy.com
  • 4. CLASSIFICATION OF ORBITAL FRACTURES I. ISOLATED FRACTURES OF ORBIATL RIM: SUPERIOR  INFERIOR  LATERAL  MEDIAL II. ISOLATED FRACTURE OF ORBITAL WALLS:  ROOF  FLOOR  MEDIAL  LATERAL  www.indiandentalacademy.com
  • 5. III. ORBITAL WALL FRACTURES: 1. BLOW OUT FRACTURE:  pure blow out fracture  impure blow out fracture 2. BLOW IN FRACTURE www.indiandentalacademy.com
  • 6. PATHOPHYSIOLOGY Bone conduction theory “buckling “  Less energy  Small fractures limited anterior floor Hydraulic theory  More energy  Larger fracture involving entire floor and medial wallentire wall  Should suspect more extensive orbit involvement with associated injuries (globe rupture)(rupture) www.indiandentalacademy.com
  • 7. CLINICAL DIAGNOSIS BASED ON AREA INVOLVED : PERIORBITAL TISSUES:  OEDEMA  SUBCONJUNCTIVAL HEMORRHAGE  CIRCUMORBITAL ECCHYMOSIS  SURGICAL EMPHYSEMA EYELIDS:  ABNORMALITY OF PALPEBRAL FISSURE  PTOSIS  PSEUDOPTOSIS LIGAMENTS:  ANTIMONGOLOID SLANT  MONGOLOID SLANT  TELECANTHUS EYE:  PRESERVATION OF VISION  LIMITATION OF OCCULAR MOVEMENTS  DIPLOPIA  ENOPTHALMOS LACRIMAL APPARATUS:  EPIPHORA NEUROLOGICAL DEFICITS:  PARESTHESIA . www.indiandentalacademy.com
  • 8. BASED ON TIMING: Early features:  Limitation of elevation of eye.  Paresthesia of infra orbital nerve.  Alteration of ocular level. Late features(after 7 to 10 days):  Diplopia  Lowering of ocular level  Enopthalmos  Deepening of supratarsal fold.  Narrowing of palpebral fissure www.indiandentalacademy.com
  • 9. INVESTIGATIONS RADIOGRAPHIC FINDINGS:  PLAIN RADIOGRAPHY.  WATERS PROJECTION. C.T SCAN &MRI:  Coronal scanning  Axial scanning  Saggital scanning MRI used for assessment of soft tissue displacement www.indiandentalacademy.com
  • 10. SPECIAL TESTS FORCED DUCTION TEST /TRACTION TEST ELECTROMY OGRAPHYdone by opthalmologist. ORBITOGRAP www.indiandentalacademy.com
  • 11. OPTHALMOLOGIC EVALUATION       Periorbital examination Visual acuity Pupillary size and shape Ocular motility Fundoscopic examination Hyphema www.indiandentalacademy.com
  • 12. DIPLOPIA Two images of same object Monocular diplopia Binocular diplopia CAUSES: EDEMA/HEMATOMA RESTRICTED MOTILITY NEUROGENIC INJURY EVALUATION: Testing ductions Forced duction test Electromyography Corneal light reflex www.indiandentalacademy.com
  • 13. MANAGEMENT TWO APPRACHES:  CONSERVATIVE APPROACH  SURGICAL APPROACH www.indiandentalacademy.com
  • 14. MANAGEMENT CONSERVATIVE APPRACH:  Several authors have put forward there concepts whether to observe or to do some early treatment or wait for some time to carry on some surgical procedure. www.indiandentalacademy.com
  • 15. MANAGEMENT OBSERVATION:  minimal diplopia  good ocular motility  no signs of enopthalmos EARLY INTERVENTION:(WITHIN TWO WEEKS)  early enopthalmos causing facial asymmetry  white eyed floor fracture (children) LATE INTERVENTION:(AFTER TWO WEEKS)  symptomatic diplopia with positive forced duction test  late enopthalmos  progressive infra orbital hypoesthesia www.indiandentalacademy.com
  • 16. Orbital Floor  When to explore? (Shumrick study)        Persistent diplopia with positive forced duction Obvious enophthalmos Comminuted orbital rim by CT >50% floor disruption by CT Combined floor/medial wall defects by CT Fracture of zygoma body by CT “Blow-in” fx with exophthalmos by PE or CT www.indiandentalacademy.com
  • 17. PUTTERMANS REVISED INDICATION:  7 days of systemic corticosteroids for the resolution of the diplopia within first 3 weeks.  Hawer & Dartzbach evaluated size of orbital floor defects &felt that fracture involving more than half the floor should be reconstructed within first 2 weeks to avoid enopthalmos  Hertel exopthalmometry(enopthalmos):alignin the ruler through both the medial canthi &noting where the ruler bisects each eye. www.indiandentalacademy.com
  • 18. CONTRAVERSIES:  Oedema  Diplopia may resolve rapidly after injury has settled.  Motility problems if not treated immediately.  Asymptomatic patient may develop diplopia or enopthalmos if not treated www.indiandentalacademy.com
  • 19. TRAP DOOR FRACTURES:(mechanical incarceration of the extra ocular muscle):  This can be diagnosed by CT & by forced duction test. Timing of repair:  children: within 5 days produces better results  adults: no specific time period. But treated after 14 days has good long period results. www.indiandentalacademy.com
  • 20. SURGICAL MANAGEMENT:  Crikelair & co workers said….in case of persistent diplopia or enopthalmos after 2 weeks –surgical repairing of orbital fractures is needed.  Persistent diplopia for 4 months following trauma-contralateral eye muscle surgery or contralateral fat resection to mask enopthalmos. www.indiandentalacademy.com
  • 21. Depending on the area & extent &also aesthetic consideration the following incisions are given for the particular area.. ORBITAL FLOOR:  SUBCILIARY INCISION.  TRANSCONJUNCTIVAL INCISION  SUB TARSAL INCISION  www.indiandentalacademy.com
  • 22. www.indiandentalacademy.com
  • 23. SUBCILIARY APPROACH www.indiandentalacademy.com
  • 24. SUBTARSAL APPROACH www.indiandentalacademy.com
  • 25. SUBCILIARY &SUBTARSAL INCISION: ADVANTAGES:  Easy &quick to do  In case of edema also estimation of giving incision can easily be made  Scar inversion is greatly diminished. DISADVANTAGES:  Vertical lid shortening  Increased incidence of impairments with subciliary incision. www.indiandentalacademy.com
  • 26. TRANSCONJUCTIVAL APPROACH www.indiandentalacademy.com
  • 27. TRANSCONJUCTIVAL APPROACH www.indiandentalacademy.com
  • 28. TRANSCONJUNCTIVAL INCISION : Advantages: Excellent aesthetics results.  Quick to do.  No skin muscle disssection  Low incidence of ectropian.  Scar can be seen only b cos of lateral extension which heals rapidly. Disadvantages:  Limitation of access  Medial extent can be limited.  www.indiandentalacademy.com
  • 29. ORBITAL ROOF & LATERAL WALL:  EYE BROW INCISION  UPPER BLEPHAROPLASTY INCISION  BI CORONAL INCISION  LATERAL CANTHOTOMY INCISION. www.indiandentalacademy.com
  • 30. EYEBROW INCISION www.indiandentalacademy.com
  • 31. UPPER BHLEPHAROPLASTY INCISION www.indiandentalacademy.com
  • 32. BICORONAL INCISION www.indiandentalacademy.com
  • 33. BICORONAL INCISION www.indiandentalacademy.com
  • 34. LATERAL CANTHOTOMY&CANTHOLYSI S www.indiandentalacademy.com
  • 35. MEDIAL ORBITAL APPROACH:  CORONAL INCISION  LATERAL NASAL INCISION  TRANSCONJUNCTIVAL APPROACH  SUB CILIARY INCISION www.indiandentalacademy.com
  • 36. MATERIALS FOR RECOSTRUCTION FUNCTIONS:  To seal off antral cavity from orbit  To provide a physiologically acceptable &physically inert smooth surface.  Restore the contour &dimension of the orbit  To provide some indirect support for the globe IDEAL REQUISITES:  Easy to mould  Easy to fixate  Biocompatible  Strong & readily available. www.indiandentalacademy.com
  • 37. MATERIALS FOR RECOSTRUCTION GRAFTS  AUTOGRAFTS(BONE OR CARTILAGE)  HOMOGRAFTS(LYOPHILISED DURAMATER)  ALLELOGRAFTS(TEFLON OR SILASTIC) www.indiandentalacademy.com
  • 38. Orbital Floor Bone Grafting  Need to support floor full 4 cm www.indiandentalacademy.com
  • 39. AUTOGRAFTS:             antral wall septal cartilage cancellous bone from mastoid calvarial bone inner plate of ileum. 8 ,9,&10 ribs at costosternal junction (children) TO SECURE THE GRAFT: soft stainless steel wire microplate or miniplate titanium mesh ADVANTAGE: high tissue compatibility DISADVANTAGE: second surgical procedure. www.indiandentalacademy.com
  • 40.       HOMOGRAFTS: disadvantages : greater susseptibility to infection increased rate of resorption. Lyophilised human dura-commonly used,gets absorbed &replaced by fibrous tissue available in pre sterilised packets. www.indiandentalacademy.com
  • 41. IMPLANTS: RESORBABLE NON RESORBABLE IMPLANTS. resorbable implants: polydiaxane polylactides non resorbable implants: titanium silicone polyethylene teflon ADVANTAGES: second operation to harvest bone is not necessary DISADVANTAGES: materials become fibrotically encapsulated causing infection www.indiandentalacademy.com
  • 42. COMPLICATIONS HEMORRHAGE /ORBITAL HEMATOMA RETROBULBAR HEMMORHAGE BLINDNESS DIPLOPIA SUPERIOR ORBITAL FISSURE SYNDROME ORBITAL APEX SYNDROME CARATICO CAVERNOUS FISTULA www.indiandentalacademy.com
  • 43. ORBITAL HEMATOMA &ITS TREATMENT www.indiandentalacademy.com
  • 44. RETROBULBAR HEMORRHAGE www.indiandentalacademy.com
  • 45. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com