Repair of orbital floor fracture #1
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:30
This video demonstrates repair of a left orbital floor fracture. As in all floor fractures, forced ductions are checked prior to starting the surgery. A toothed forcep used to fixate the globe at the insertion of the inferior rectus muscle. 4–0 silk sutures are placed through the eyelid margin in order to provide traction during the case. A needle tip cautery is then used to make a trans-conjunctival incision inferior to the inferior border the tarsus extending from the level of the punctum medially to the lateral canthus laterally. Dissection is then carried out between the orbicularis muscle and the orbital septum. A 4–0 silk traction suture is placed through the cut end of the lower lid retractors and conjunctiva. Dissection is continued toward the inferior orbital rim. In this case, a lateral canthotomy and inferior cantholysis are not performed. The periosteum is identified and incised with the needle tip cautery. A Freer periosteal elevator is then used to elevate the periosteum from the orbital floor. The fracture is identified and the tissue is elevated from the fracture. The posterior extent of the fracture is identified and a suction tip is used to measure the distance between the posterior shelf of the fracture and the orbital rim. Forced ductions are checked which are now free. In this case, a Supramid implant is used to cover the fracture. The implant is fixated to the orbital rim using a drill followed by a 1 by 4 millimeter screw. The placement and subperiosteal position of the implant is checked. Forced ductions are again checked which are demonstrated to be free. The trans-conjunctival incision is then closed with 4 interrupted 7–0 Vicryl sutures. At the conclusion of the case, erythromycin ophthalmic ointment is placed in the fornix.