RTA 6 months NOE and Floor of the Orbit Fracture Malunion Resurgery

RTA 6 months NOE and Floor of the Orbit Fracture Malunion Resurgery

Accident victim with facial asymmetry from previous surgery presents for correction

This young man is from Ratnagiri, Tamil Nadu. A road accident suffered around six months ago resulted in a nasoorbitoethmoidal complex and floor of orbit fracture. He had also suffered a tear to the inner canthus of the left eye. He had already been operated twice elsewhere, which left him with mild facial asymmetry and he also had residual diplopia and inner canthal misalignment. His family had consulted with a local surgeon who referred him to our hospital.

Treatment planning for correction explained in detail to the patient

Dr SM Balaji, facial trauma care expert, examined the patient and ordered imaging studies. He explained the treatment plan to the patient who consented for surgery. This included repositioning of the inner canthus to its previous position. Treatment of the residual diplopia would be through release of the entrapped muscles from the orbital floor. The depression in the zygoma also needed to be addressed. The patient agreed to the treatment plan and consented to surgery.

Successful surgical correction of cosmetic and functional deficits

Under general anesthesia, the left cheek scar from the previous surgery was incised. The old plate was then removed from this region. The zygomatic bone was then refixed in an elevated position. A lateral canthal incision was next made. Using the skin incision to access the orbital floor, entrapped muscles from the orbital floor were released. This would correct his diplopia. A Titanium mesh with Medpor was then placed for orbital floor reconstruction. This was then attached to the infraorbital rim with screws. The inner canthus was next incised and reattached in correct anatomical alignment using a double arm suture needle and the outer canthus was next aligned and closed with sutures. The incision at the old scar site was then closed with sutures.

The patient expressed complete satisfaction with the cosmetic results before discharge.

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