Orbital Roof Fracture Management

The approach used is determined by the surgical needs of the patient.

Orbital roof fracture management.

Investigation of orbital fractures is by x ray and ct with ct being the modality of choice though it can be unreliable in children with blowout fractures. An interdisciplinary approach with plastic surgery ophthalmology and neurosurgery is crucial to providing comprehensive care. A ct may already be appropriate due to a mechanism of injury or red flags for a head injury. Even in the context of floor fractures dr.

Most can be safely observed. After a thorough ophthalmic exam and after other trauma has been ruled out the patient and physician. Approaches include extracranial intracranial and endonasal endoscopic. Another potential emergency involves the roof not the floor of the orbit.

Nondisplaced or minimally displaced orbital roof fractures are usually managed by observation but displaced orbital roof fractures can cause ophthalmic and neurologic complications and open surgical intervention is occasionally required. However intracranial or intraorbital injury may warrant surgical intervention to remove impinging bony fragments repair dura or reconstruct the orbital roof. Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. Surgically bicoronal approaches were performed most commonly along with reconstruction utilizing titanium miniplates.

Management of orbital roof fractures varies based on individual clinical features including the presence of exophthalmos gaze restriction and concomitant injuries such as dural tears. When the inner table of the orbital roof is not involved and there is no dural tear the orbital fracture can be accessed by superior orbitotomy.