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Double vision (Diplopia) correction of orbital blow out – eye bone fracture

24/11/2014

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A 42 year old man from West Bengal reported to our hospital for treatment of fractures of his face bones that he had sustained in a vehicular accident. His 3D CT scan showed right Le Fort I fracture & nasal bone fracture. Also there was left orbital blow out fracture and fracture of the lateral orbital wall on the left side. The patient had enopthalmus (sunken eyes) and diplopia (double vision) in the left eye.

Maxillofacial Surgeon Dr. S. M. Balaji successfully performed the facial fracture rehabilitation. Under general anesthesia, iliac graft was obtained from the medial cortex using trap door technique. Upper central and lateral incisors were extracted; implants were placed in the freshly extracted sockets.  To compensate for the bony defect, iliac bone was placed and fixed using screws. To address the orbital floor fracture, transconjuctival incision was placed with lateral canthotomy. The fracture along the frontozygomatic suture and lateral orbital wall was stabilized using bone plates and screws, the herniated orbital contents were then retracted. Titanium mesh contoured, adapted over the floor and fixed using screws. Iliac graft placed over the mesh.  The nasal bone was elevated and a nasal pack placed. On the 3rd post-operative day the patient demonstrated full range of ocular movements with regression of double vision. 
Preoperative facial view showing enolphthalmus and asymmetrical appearance and sunken left eye leading to diplopia
Preoperative 3DCT scan view showing fractured orbital floor and lateral wall with depressed orbital floor giving altered levels of orbit
By following trap door technique cortical bone was obtained from iliac crest
Infected teeth from upper front region of the jaw was extracted
Nobel implant placed in the missing teeth region and bone graft was fixed and implant was completely covered and stabilized
Titanium mesh was used to reconstruct the orbital floor
Titanium mesh was fixed in the floor of the orbit and sunken orbital content was raised from the fractured bone segments
Iliac bone graft was used to raise the orbital floor and fractued lateral orbital wall also fixed with mini boneplate
Postoperative view after 2 weeks showing corrected orbit level and lateral orbital wall positioned giving enhanced appearance
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