POST TRAUMATIC ORBITAL
FLOOR RECONSTRUCTION
GENERAL CONSIDERATIONS & TREATMENT OPTIONS

INDIAN DENTAL ACADEMY
Leader in co...
‘ SO CLOSELY DO THE FEATURES
DEPEND FOR THEIR FORM UPON
THEIR BONY SUPPORT THAT LOSS
OF EVEN A SMALL PORTION OF ONE
OF THE...
INTRODUCTION


BONY ORBIT HOUSES IMPORTANT
STRUCTURES OF THE FACIAL SKELETON



PRECISE KNOWLEDGE OF ANATOMY
REQUIRED FO...
CLASSIFICATION – ORBITAL FLOOR #
-- PURE BLOW OUT #
Fujino et al
-- LINEAR #
 BLOW OUT # -- Smith & Regan
 BLOW IN # -- ...
CLINICAL FEATURES
EYELID EDEMA
 CIRCUMORBITAL ECCHYMOSIS
 SUBCONJUNCTIVAL HEMORRHAGE
 ALTERATION OF VISUAL AXIS
 PARES...
www.indiandentalacademy.com
RADIOGRAPHIC SIGNS





FOR BLOW OUT #s (ZIZMOR et al)
Orbital floor fragmentation
Displacement of fragments
“Hanging d...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
When to intervene and reconstruct
 Persistent

diplopia & enophthalmos
 Muscle entrapments
 Depression / elevation- inf...
Timing of repair
 Deferred

for 5-7 days
 Immediate intervention
-- traumatic optic neuropathy
-- increased I.O pressure...
GUIDELINES FOR SURGICAL
EXPLORATION
 Infraorbital

.f to midpoint of IOF—24mm
 ALC--AEF– 24mm
 ALC– medial aspect of OC...
TREATMENT GOALS

AIMS
Preservation of binocular vision
Restoration and reconstruction
of bony orbit
www.indiandentalacad...
TREATMENT MODALITIES
Antral

packing/ floor grafting with
antral support
Reconstruction with autogenous /
allogenous bon...
ANTRAL PACKING
Indications
 Communition

with fragments retaining periosteal

attachments
 “Trap door type” #s

Approach...
GRAFTING AND ANTRAL SUPPORT
Indication
Severe loss of bone from posterior limit of orbital
floor
complication
Increased ri...
ORBITAL FLOOR GRAFTING
Functions of Ideal graft:• Seal orbit from antrum
• Restore orbital contour & dimensions
• Inert sm...
Autografts
 For

defects 1 – 1.5cm dia
 Ideal graft material
 Inserted with cortical surface towards globe
 About 1/3r...
Auto grafts (Contd.)
Antral Wall
 Nasal septal cartilage
 Cancellous bone ( Mastoid)
 Iliac crest (inner table)
 Ramus...
Allografts
Allogenic bone & Cartilage not used now
 Lyophilised dura ( Luhr – 1969)


•
•


Disadv of dura:Not for larg...
Alloplasts
 Inserted

subperiosteally
 Encapsulated by fibrous tissue
 Medpore for primary orbital floor #’s
& Secondar...
Alloplastic materials
Silicone polymers
 Teflon ( Freeman – 1962)
 Poly vinyl sponge (Henderson – 1963)
 Dacron reinfor...
Graft Fixation
With

28g wire / resorbable suture
Engaging lip of alloplastic
material into # site

www.indiandentalacad...
Complications
Persistent enophthalmos
 Depression of globe
 Persistent diplopia in vertical gaze
 Extrusion of implant
...
www.indiandentalacademy.com
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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

  1. 1. POST TRAUMATIC ORBITAL FLOOR RECONSTRUCTION GENERAL CONSIDERATIONS & TREATMENT OPTIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. ‘ 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
  3. 3. INTRODUCTION  BONY ORBIT HOUSES IMPORTANT STRUCTURES OF THE FACIAL SKELETON  PRECISE KNOWLEDGE OF ANATOMY REQUIRED FOR ORBITAL TRAUMA REPAIR www.indiandentalacademy.com
  4. 4. CLASSIFICATION – ORBITAL FLOOR # -- PURE BLOW OUT # Fujino et al -- LINEAR #  BLOW OUT # -- Smith & Regan  BLOW IN # -- Dingman & Natvig(1964) www.indiandentalacademy.com
  5. 5. CLINICAL FEATURES EYELID EDEMA  CIRCUMORBITAL ECCHYMOSIS  SUBCONJUNCTIVAL HEMORRHAGE  ALTERATION OF VISUAL AXIS  PARESTHESIA  DIPLOPIA  ENOPTHALMOS  RESTRICTION OF OCULAR MOVEMENT  www.indiandentalacademy.com
  6. 6. www.indiandentalacademy.com
  7. 7. RADIOGRAPHIC SIGNS    FOR BLOW OUT #s (ZIZMOR et al) Orbital floor fragmentation Displacement of fragments “Hanging drop sign” www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. www.indiandentalacademy.com
  10. 10. www.indiandentalacademy.com
  11. 11. 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
  12. 12. Timing of repair  Deferred for 5-7 days  Immediate intervention -- traumatic optic neuropathy -- increased I.O pressure -- direct muscle injuries www.indiandentalacademy.com
  13. 13. 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
  14. 14. TREATMENT GOALS AIMS Preservation of binocular vision Restoration and reconstruction of bony orbit www.indiandentalacademy.com
  15. 15. TREATMENT MODALITIES Antral packing/ floor grafting with antral support Reconstruction with autogenous / allogenous bone/ alloplasts www.indiandentalacademy.com
  16. 16. ANTRAL PACKING Indications  Communition with fragments retaining periosteal attachments  “Trap door type” #s Approach: standard Caldwell Luc www.indiandentalacademy.com
  17. 17. GRAFTING AND ANTRAL SUPPORT Indication Severe loss of bone from posterior limit of orbital floor complication Increased risk of graft infections www.indiandentalacademy.com
  18. 18. ORBITAL FLOOR GRAFTING Functions of Ideal graft:• Seal orbit from antrum • Restore orbital contour & dimensions • Inert smooth surface • Indirect globe support www.indiandentalacademy.com
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. Alloplasts  Inserted subperiosteally  Encapsulated by fibrous tissue  Medpore for primary orbital floor #’s & Secondary enophthalmos reconstruction www.indiandentalacademy.com
  23. 23. 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
  24. 24. Graft Fixation With 28g wire / resorbable suture Engaging lip of alloplastic material into # site www.indiandentalacademy.com
  25. 25. 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 
  26. 26. www.indiandentalacademy.com

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