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Dental tissues and their replacements/ oral surgery courses
Orbital floor reconstruction /certified fixed orthodontic courses by Indian dental academy
1. POST TRAUMATIC ORBITAL
FLOOR RECONSTRUCTION
GENERAL CONSIDERATIONS & TREATMENT OPTIONS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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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)
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3. INTRODUCTION
BONY ORBIT HOUSES IMPORTANT
STRUCTURES OF THE FACIAL SKELETON
PRECISE KNOWLEDGE OF ANATOMY
REQUIRED FOR ORBITAL TRAUMA REPAIR
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4. CLASSIFICATION – ORBITAL FLOOR #
-- PURE BLOW OUT #
Fujino et al
-- LINEAR #
BLOW OUT # -- Smith & Regan
BLOW IN # -- Dingman & Natvig(1964)
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5. CLINICAL FEATURES
EYELID EDEMA
CIRCUMORBITAL ECCHYMOSIS
SUBCONJUNCTIVAL HEMORRHAGE
ALTERATION OF VISUAL AXIS
PARESTHESIA
DIPLOPIA
ENOPTHALMOS
RESTRICTION OF OCULAR MOVEMENT
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7. RADIOGRAPHIC SIGNS
FOR BLOW OUT #s (ZIZMOR et al)
Orbital floor fragmentation
Displacement of fragments
“Hanging drop sign”
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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
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12. Timing of repair
Deferred
for 5-7 days
Immediate intervention
-- traumatic optic neuropathy
-- increased I.O pressure
-- direct muscle injuries
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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
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17. GRAFTING AND ANTRAL SUPPORT
Indication
Severe loss of bone from posterior limit of orbital
floor
complication
Increased risk of graft infections
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18. ORBITAL FLOOR GRAFTING
Functions of Ideal graft:• Seal orbit from antrum
• Restore orbital contour & dimensions
• Inert smooth surface
• Indirect globe support
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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
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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
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