Orbital Fracture Surgery - Sunken Eye surgery
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Orbital Fracture Surgery
When patients experience facial trauma, one of the more common outcomes that can occur are fractures around the eye. The bony orbit is designed to buckle under the pressure caused by blunt impact. This buckling prevents the force of the injury from damaging the eye itself. Fractures can present in a variety of different ways and require thorough examination before deciding on the best treatment option.
I fell and have a black eye and cheek pain. Do I have a fracture?
Depending upon the impact of the injury and the exact location of the impact, a fracture is certainly possible in this scenario. When being evaluated, it is important to have an eye exam in addition to an examination of your bones. An eye exam will help remove any concern that the eye itself was injured, and a bone exam will determine if a fracture is present. Fractures can be present even when the eye exam looks normal.
How do you determine if a fracture is present?
The presence of a fracture is determined by history, exam, and imaging. Dr. Dewan will take a thorough history to determine the type, force, and location of impact. An exam will consist of ensuring your eye is healthy, and then feeling for bony inconsistencies in the face. Measurements will be made on the position of your eyes. You will also be tested for numbness along the cheek or upper jawline. Finally, a CT scan will be obtained of the face to examine for the presence of facial fractures.
If I have a fracture, will I have to have surgery?
Not all fractures of the orbit require surgery. In many cases, the fracture is allowed to heal on its own and no long-term effects are anticipated or noticeable. Whether surgery is required depends on many factors. These include whether the eye has sunk back into the fracture, whether constant double vision is present, and the size of the fracture on the CT scan. Dr. Dewan will make measurements on all of these factors during your examination to help construct a plan for your fracture.
If I need surgery, what is that like?
Most fractures involve the floor of the eye socket. In these cases, orbital fracture surgery is performed in the operating room with you completely asleep. In most cases, Dr. Dewan makes an incision on the inside of your lower eyelid that carries into the outside corner of the lid. From here, Dr. Dewan can access the fracture and lift any tissue that has fallen into your fracture. A plate is placed over the fracture to prevent any tissue from falling in again. The incision is then sutured and a bandage is placed over your eye.
What is the healing like for fracture repair?
Most patients have a minimal amount of pain following fracture repair. Tylenol and ibuprofen are the typical pain medicines necessary, though occasionally some patients may need stronger pain control. Antibiotics are typically taken as well for 1 week following surgery and ointment is placed on the corner of the eye. Stitches will dissolve on their own over the first week. Some patients may continue to have double vision for a few weeks following surgery. Numbness, if present before surgery, may also last several weeks after surgery and will improve on its own.
Dr. Dewan will see you for a post-operative visit 1 week after surgery and 1 month after that.
If I don’t need surgery, what can I expect to happen?
Most patients who do not require surgery will notice steady improvement in their symptoms. Double vision will continue to improve over several weeks. Numbness of the cheek or teeth can last 6-8 weeks on average as well. Pain is usually minimal after the bruising and swelling from the injury subside. You are generally free to do most activities, however, bending, lifting heavy objects, and vigorous blowing of your nose are to be avoided.
Ok, I’d like a consultation. What should I do?
Dr. Dewan is happy to help you with a possible orbital fracture. When you schedule a consultation, anticipate an office visit that may take up to an hour. Dr. Dewan will take a thorough history and perform an exam. If you have had a CT scan already, please bring a CD containing the images with you. If not, he will order a scan for you. At the end of your consultation, Dr. Dewan will discuss his findings and recommend a plan for you.
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