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Orbital floor reconstruction /certified fixed orthodontic courses by Indian dental academy
 

Orbital floor reconstruction /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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    Orbital floor reconstruction /certified fixed orthodontic courses by Indian dental academy Orbital floor reconstruction /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • POST TRAUMATIC ORBITAL FLOOR RECONSTRUCTION GENERAL CONSIDERATIONS & TREATMENT OPTIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • ‘ SO CLOSELY DO THE FEATURES DEPEND FOR THEIR FORM UPON THEIR BONY SUPPORT THAT LOSS OF EVEN A SMALL PORTION OF ONE OF THE FACIAL BONES WILL GENERALLY ENTAIL A GREAT DISFIGUREMENT” - J.ASHURST-AMERICAN JOURNAL OF MEDICAL SCIENCES(1864) www.indiandentalacademy.com
    • INTRODUCTION  BONY ORBIT HOUSES IMPORTANT STRUCTURES OF THE FACIAL SKELETON  PRECISE KNOWLEDGE OF ANATOMY REQUIRED FOR ORBITAL TRAUMA REPAIR www.indiandentalacademy.com
    • CLASSIFICATION – ORBITAL FLOOR # -- PURE BLOW OUT # Fujino et al -- LINEAR #  BLOW OUT # -- Smith & Regan  BLOW IN # -- Dingman & Natvig(1964) www.indiandentalacademy.com
    • CLINICAL FEATURES EYELID EDEMA  CIRCUMORBITAL ECCHYMOSIS  SUBCONJUNCTIVAL HEMORRHAGE  ALTERATION OF VISUAL AXIS  PARESTHESIA  DIPLOPIA  ENOPTHALMOS  RESTRICTION OF OCULAR MOVEMENT  www.indiandentalacademy.com
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    • RADIOGRAPHIC SIGNS    FOR BLOW OUT #s (ZIZMOR et al) Orbital floor fragmentation Displacement of fragments “Hanging drop sign” www.indiandentalacademy.com
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    • When to intervene and reconstruct  Persistent diplopia & enophthalmos  Muscle entrapments  Depression / elevation- inferior orbital rim  Cosmetic deformities  Orbital floor defects> 50%  Prolapse of orbital contents www.indiandentalacademy.com
    • Timing of repair  Deferred for 5-7 days  Immediate intervention -- traumatic optic neuropathy -- increased I.O pressure -- direct muscle injuries www.indiandentalacademy.com
    • GUIDELINES FOR SURGICAL EXPLORATION  Infraorbital .f to midpoint of IOF—24mm  ALC--AEF– 24mm  ALC– medial aspect of OC—42mm  FZ suture to SOF– 40mm  Supraorbital notch – SOF—40mm  Supraorbital notch– superior aspect of OC—45mm www.indiandentalacademy.com
    • TREATMENT GOALS AIMS Preservation of binocular vision Restoration and reconstruction of bony orbit www.indiandentalacademy.com
    • TREATMENT MODALITIES Antral packing/ floor grafting with antral support Reconstruction with autogenous / allogenous bone/ alloplasts www.indiandentalacademy.com
    • ANTRAL PACKING Indications  Communition with fragments retaining periosteal attachments  “Trap door type” #s Approach: standard Caldwell Luc www.indiandentalacademy.com
    • GRAFTING AND ANTRAL SUPPORT Indication Severe loss of bone from posterior limit of orbital floor complication Increased risk of graft infections www.indiandentalacademy.com
    • ORBITAL FLOOR GRAFTING Functions of Ideal graft:• Seal orbit from antrum • Restore orbital contour & dimensions • Inert smooth surface • Indirect globe support www.indiandentalacademy.com
    • Autografts  For defects 1 – 1.5cm dia  Ideal graft material  Inserted with cortical surface towards globe  About 1/3rd (25%) resorbs  Iliac crest grafts not indicated in children  Always over correct floor defects www.indiandentalacademy.com
    • Auto grafts (Contd.) Antral Wall  Nasal septal cartilage  Cancellous bone ( Mastoid)  Iliac crest (inner table)  Ramus  Coronoid, Symphysis  Rib  Tibia  Auricular Cartilage  Zygomatic Buttress  Calvarial Bone  www.indiandentalacademy.com
    • Allografts Allogenic bone & Cartilage not used now  Lyophilised dura ( Luhr – 1969)  • •  Disadv of dura:Not for large defects Cannot correct enophthalmos “ Creutzfeld – Jakob disease” • For defects up to 2 cm dia www.indiandentalacademy.com
    • Alloplasts  Inserted subperiosteally  Encapsulated by fibrous tissue  Medpore for primary orbital floor #’s & Secondary enophthalmos reconstruction www.indiandentalacademy.com
    • Alloplastic materials Silicone polymers  Teflon ( Freeman – 1962)  Poly vinyl sponge (Henderson – 1963)  Dacron reinforced silastic (Lerman & Cramer – 1964)  Dacron urethane (Leake etal – 1980)  Al: oxide ceramic ( Niederdellman etal –1976)  Tantalum gauze ( Prowler – 1965)  Marlex mesh, Gelfilm  Porous Polyethylene (Medpore) – Rubin (1961)  www.indiandentalacademy.com
    • Graft Fixation With 28g wire / resorbable suture Engaging lip of alloplastic material into # site www.indiandentalacademy.com
    • Complications Persistent enophthalmos  Depression of globe  Persistent diplopia in vertical gaze  Extrusion of implant  Infection & C/c fistula formation  Ectropion  Intra Orbital hemmorhage  Edema of lower eyelid  Tissue reaction to implant  Dacryocystitis  Blindness www.indiandentalacademy.com 
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