Abstract

SO.08.10

Blow out fracture 40 years ago – Can we still improve motility?

Pia Scharpenack1, Christian Kandzia1, Stephan Becker2, Johann Roider1
1Orth- und Pleoptik, Klinik für Ophthalmologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, 2Klinik für Mund-, Kiefer- und Gesichtschirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Objective
The treatment of orbital blowout fractures can be challenging especially if a relevant deficit of ocular motility is found. The reconstruction of orbital bone defects is as important as the following surgical treatment of the motility disorders. We report on a patient who had an orbital trauma 40 years ago. We performed an orbital reconstruction and a strabological surgery to achieve binocular vision without forced posture of the head.
Methods
We saw a 62-year-old patient who had suffered from diplopia which forced her into a painful posture of the head according to an elevation deficit and a hypotropia of the left eye. The reason of the motility disorder was an untreated orbital floor fracture with entrapment of the inferior rectus muscle by a farming accident when the patient was 15 years old. Over the years the patient was able to achieve binocular vision by reclination of the head. The patient was always advised against surgical treatment. Now the patient was encouraged to consult our clinic by her orthopaedist. We recommended surgery of the orbital bone defect and the muscular disorder in two steps. First we performed a covering of the orbital floor defect with tabula externa to elevate the orbital tissue. After 3 months we performed a 10 mm recession of the inferior rectus muscle with mobilisation and adhaesiolysis of the inferior oblique muscle.
Results
After reconstruction of the orbital floor the lowered eyeball could be elevated. The motility disorder could not be improved. After strabological surgery elevation of the left eye was possible up to 20° above primary position. Downward movement of the eye was not severely limited. The visual range for the normal use is free of diplopia without forced posture of the head.
Conclusions
Improvement of function and aesthetics can be achieved even decades after orbital trauma. Close interdisciplinary cooperation of the oral and maxillofacial surgeon and the strabological surgeon can lead to optimized  functional results.

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