This is a case of 42 year old who reported to us for management of facial bone fracture. Patient has right Le Fort I fracture, nasal bone fracture left orbital blow out fracture. The patient has enopthalmus and diplopia of the left eye. The patient also has non vital 11 and mobile 12. The CT scans demonstrating the fracture of the lateral orbital wall. The sagittal section of CT scan showing floor of the obit fracture and herniation of the orbital contents into the antrum. Hence the plan was open reduction and internal fixation of the fracture and reconstruction of the orbital floor defect using titanium mesh and iliac graft. 11 and 12 is planned for extraction and immediate implant placement. Under general anesthesia, surgical preparations are made. The iliac graft is obtained from the medial cortex. Now 11 and 12 are extracted and release incisions are made to reflect the flap. Implants are then placed in the freshly extracted sockets. To compensate for the bony defect, iliac bone is placed and fixed using screws. The fracture is then stabilized using plates and screws and wound is closed. To address the floor fracture, transconjuctival incision is placed with lateral canthotomy. Layer wise dissection is done to reach the fracture site. The fracture along the frontozygomatic suture and lateral orbital wall is stabilized using plates and screws the herniated orbital contents and then retracted. Titanium mesh contoured, adapted over the floor and fixed using screws. Iliac graft placed over the mesh. Lateral canthal ligament repositioned and closure done layer wise. The nasal bone is then elevated and a nasal pack is placed. Patient extubated. Recovery spontaneous and uneventful. Post operative review of the patient demonstrating full range of ocular movements and the regression of the double vision.
Posted on: Thu, 30 Oct 2014 14:25:44 +0000
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