21390 Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant

Name of the Procedure:

Open Treatment of Orbital Floor Blowout Fracture; Periorbital Approach, with Alloplastic or Other Implant

Summary

This surgical procedure repairs a fractured orbital floor, which is the bone at the bottom of the eye socket. Through an incision near the eye, the surgeon uses alloplastic (synthetic) implants or other materials to reinforce and reconstruct the damaged area.

Purpose

This procedure addresses fractures in the orbital floor, often resulting from trauma or injury to the eye. The primary goals are to restore normal eye function, prevent complications like double vision or sunken eye appearance, and alleviate symptoms.

Indications

• Double vision (diplopia)
• Enophthalmos (sunken eye)
• Limited eye movement
• Facial asymmetry
• Significant orbital pain
• Radiologic evidence of an orbital floor fracture

Preparation

• Patients may need to fast for several hours before the procedure.
• Preoperative imaging, such as CT scans, to assess the extent of the fracture.
• Adjustments to current medications, especially blood thinners.
• Baseline eye examinations to document vision status.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: A small incision is made, usually along the lower eyelid or sometimes inside the mouth.
3. Access: The surgeon exposes the fractured orbital floor.
4. Repair: Carefully reduces any herniated tissue and implants an alloplastic material or other suitable implant to reconstruct the orbit.
5. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Performed in a hospital or surgical center equipped for general surgery.

Personnel

• Ophthalmic or Maxillofacial Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Scarring
• Altered sensation around the incision site
• Persistent double vision
• Implant displacement
• Anesthesia-related risks

Benefits

• Restoration of normal eye appearance and function
• Relief from double vision and other visual disturbances
• Prevention of long-term complications
• Improved facial symmetry

Recovery

• Post-operative care includes pain management and application of ice packs.
• Instructions on head elevation and activity restrictions.
• Temporary dietary adjustments if the incision was inside the mouth.
• Follow-up appointments for suture removal and monitoring healing.
• Recovery time varies but generally spans several weeks.

Alternatives

• Observation: Mild fractures without severe symptoms might be monitored without immediate surgery.
• Nonsurgical management: Temporary use of prism glasses to manage double vision.
• Minimally invasive approach: Endoscopic surgery, which might not be suitable for all fracture types.

Pros and cons bring into consideration the severity of the fracture, potential risks, and the need for reconstructive precision.

Patient Experience

During the procedure, patients will be under general anesthesia and won't feel pain. Post-operatively, there may be some discomfort, swelling, and bruising around the eye, manageable with prescribed medications. Pain and swelling generally subside within a few days to weeks.