Repair of orbital floor fracture using headlight mounted cam
This is Richard Allen at the University of Iowa. This video demonstrates repair of a right orbital floor fracture. Forced ductions are checked which are shown to be positive. The left side, which is uninvolved is checked to compare. This video is in the surgeon's view due to the fact that the camera used in this video is mounted to the headlight. A lateral canthotomy and inferior cantholysis are then performed. A transconjunctival incision is then made with the monopolar cautery and dissection is carried out between the orbicularis muscle and the orbital septum. A 4-0 silk suture is place though the edge of the conjunctiva. The inferior orbital rim is then exposed and incised with the monopolar cautery. The periosteum is then elevated from the orbital floor until the fracture is encountered. The tissue is noted to be incarcerated in the fracture. There is an anterior lip of the fracture which is catching the tissue. Therefore a rongeur will be used to remove a portion of the anterior lip so that the tissue can be released. Forced ductions are now checked which are found to be free. The distance from the orbital rim to the posterior edge of the fracture is measured with the suction tip. A Supramid implant is then fashion to cover the fracture. This is a nylon sheet which is useful for moderately sized fractures. The implant is placed in a subperiosteal plane so that the back part of the implant rests on the posterior ledge of the fracture. The implant is fixated into position with titanium screws. Inspection shows that no tissue is caught under the implant. Forced ductions are again checked and are shown to be free. The transconjunctival incision is closed with 7-0 Vicryl suture. The cantholysis is repaired with a lateral tarsal strip procedure. The strip is sutured to the lateral orbital rim at the level of Whitnall's tubercle with 4-0 Mersilene suture. The canthotomy incision can then by closed with 7-0 Vicryl suture. At the conclusion of the case, antibiotic ointment is placed in the eye.