Management of old naso-orbital fractures with ocular involvement and associated complications caused by facial trauma

  • Alia Arianti Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Kirana Hospital, Jakarta
  • Yunia Irawati Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Kirana Hospital, Jakarta
Keywords: facial trauma, management, naso-orbital fracture, ocular complications

Abstract

A 14-years-old boy came with chief complaint of epiphora and history of globe rupture repair surgery due to facial trauma one year ago. Patient got complications from the trauma, including nasolacrimal duct obstruction, phthisis bulbi, enophthalmos, facial deformities, and ptosis. Multidisciplinary approach was performed simultaneously in one session surgery which included oral mucosal graft for non-irritative phthisis bulbi, silicone block implant for blowout fracture, external dacrycystorhinostomy for obstructed nasolacrimal duct, fascia lata brow suspension/frontalis sling for ptosis, and septorhinoplasty for nasal augmentation. After the surgery, symptoms of epiphora had resolved and aesthetical improvement of facial deformities was also prominent. Management of old orbital fracture poses additional challenges due to the complications that have occurred over time. Loss of functionality may seem impractical to manage because no function can be pertained. Nevertheless, it is important to still perform surgical repair for aesthetic purposes due to the psychological effect on their daily lives.

Downloads

Download data is not yet available.

References

  1. Magarakis M, Mundinger GS, Kelamis JA, Dorafshar AH, Bojovic B, Rodriguez ED. Ocular injury, visual impairment, and blindness associated with facial fractures: a systematic literature review. Plast Reconstr Surg. 2012;129(1):227–33. https://doi.org/10.1097/PRS.0b013e3182362a6d

  2. Myga-Porosilo J, Skrzelewski S, Sraga W, Borowiak H, Jackowska Z, Kluczewska E. CT imaging of facial trauma. Role of different types of reconstruction. Part I - Bones. Pol J Radiol. 2011;76(1):41–51.

  3. Chen C-T, Chen Y-R. Update on orbital reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2010;18(4):311–6. https://doi.org/10.1097/MOO.0b013e32833aafd2

  4. Roth FS, Koshy JC, Goldberg JS, Soparkar CNS. Pearls of orbital trauma management. Semin Plast Surg. 2010;24(4):398–410. https://doi.org/10.1055/s-0030-1269769

  5. Dunkin JM, Crum AV, Swanger RS, Bokhari SA. Globe trauma. Semin ultrasound CT MR. 2011;32(1):51–6. https://doi.org/10.1053/j.sult.2010.09.003

  6. Cole P, Kaufman Y, Hollier L. Principles of facial trauma: orbital fracture management. J Craniofac Surg. 2009;20(1):101–4. https://doi.org/10.1097/SCS.0b013e318190e1b6

  7. Nguyen M, Koshy JC, Hollier LH. Pearls of nasoorbitoethmoid trauma management. Semin Plast Surg. 2012;24(4):383–8. https://doi.org/10.1055/s-0030-1269767

  8. Thakkar P, Patel JR, Sethuraman R, Nirmal N. Custom ocular prosthesis: a palliative approach. Indian J Palliat Care. 2012;18(1):78–83. https://doi.org/10.4103/0973-1075.97480

  9. Girotto JA, MacKenzie E, Fowler C, Redett R, Robertson B, Manson PN. Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg. 2001;108:312–27. https://doi.org/10.1097/00006534-200108000-00005

  10. Cole P, Boyd V, Banerji S, Hollier LH Jr. Comprehensive management of orbital fractures. Plast Reconstr Surg. 2007;120 (Suppl. 2):57S–63S. https://doi.org/10.1097/01.prs.0000260752.20481.b4

  11. Lindsey JL, Hamill MB. Scleral and corneoscleral injuries. In: Kuhn F, Pieramici DJ, editors. Ocular Trauma Principles and Practice. New York: Thieme; 2002. p. 111–22.

  12. Schmack I, Volcker HE, Grossniklaus HE. Phthisis bulbi. In: Levin LA, Albert DM, editors. Ocular Disease Mechanism and Management. USA: Saunders Elsevier 2010. p. 415–23. https://doi.org/10.1016/B978-0-7020-2983-7.00054-1

  13. Ma'luf RN, Awwad ST. Mucous membrane graft versus gunderson conjunctival flap for fitting a scleral shell over a sensitive cornea. Ophthal Plast Reconstr Surg. 2005;21(5):356–8. https://doi.org/10.1097/01.iop.0000175058.93880.91

  14. Mai C, Bertelmann E. Oral Mucosal Graft: Old technique in new light. Ophthalmic Res. 2013;50(2):91–8. https://doi.org/10.1159/000351631

  15. Aggarwal H, Singh RD, Kumar P, Gupta SK, Alvi HA. Prosthetic Guidelines for ocular rehabilitation in patients with phtisis bulbi: a treatment-based classification system. J Prosthet Dent. 2014;111(6):525–8. https://doi.org/10.1016/j.prosdent.2013.08.013

  16. Burnstine M. Clinical recommendations for repair isolated orbital floor fractures: an evidence-based analysis. Ophthalmology. 2002;109(7):1207–10. https://doi.org/10.1016/S0161-6420(02)01057-6

  17. Rinna C, Ungari C, Saltarel A, Cassoni A, Reale G. Orbital floor restoration. J Craniofac Surg. 2005;16(6):968–72. https://doi.org/10.1097/01.scs.0000186308.16795.8b

  18. Prowse SJ, Hold PM, Gilmour RF, Pratap U, Mah E, Kimble FW. Orbital floor reconstruction: a case for silicone. A 12 years experience. J Plast Reconstr Aesthet Surg. 2010;63(7):1105–9. https://doi.org/10.1016/j.bjps.2009.05.057

  19. Ali MJ, Gupta H, Honavar SG, Naik MN. Acquired nasolacrimal duct obstructions secondary to naso-orbito-ethmoidal fractures: patterns and outcomes. Ophthal Plast Reconstr Surg. 2012;28(4):242–5. https://doi.org/10.1097/IOP.0b013e31823f3266

  20. Nerad JA. Diagnosis and management of the patient with tearing. In: Nerad JA, editor. Techniques in Ophthalmic Plastic Surgery. Cincinnati: Saunders Elsevier; 2010. p. 260–96.

  21. Becelli R, Renzi G, Mannino G, Cerulli G, Lannetti G. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. J Craniofac Surg. 2004;15(1):29–33. https://doi.org/10.1097/00001665-200401000-00011

  22. Finsterer J. Ptosis: causes, presentation, and management. Aesth Plast Surg. 2003;27(3):193–204. https://doi.org/10.1007/s00266-003-0127-5

Published
2018-05-08
How to Cite
Arianti, A., & Irawati, Y. (2018). Management of old naso-orbital fractures with ocular involvement and associated complications caused by facial trauma. Medical Journal of Indonesia, 27(1), 54-61. https://doi.org/10.13181/mji.v27i1.1959
Section
Case Report