Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)
CPT4 code
Name of the Procedure:
Open Treatment of Orbital Floor Blowout Fracture; Transantral Approach (Caldwell-Luc Type Operation)
Summary
This procedure involves surgically repairing a fracture of the orbital floor (the bone beneath the eye) using an approach through the upper jaw, accessing the orbital floor via the maxillary sinus. This method helps to correct displaced bone fragments and restore the normal anatomy of the eye socket.
Purpose
The procedure addresses orbital floor blowout fractures that may result from trauma to the eye region. The goals are to restore the normal anatomy of the orbital floor, alleviate symptoms such as double vision, and prevent long-term complications like enophthalmos (sunken eye).
Indications
- Symptoms such as double vision (diplopia)
- Sunken eye (enophthalmos)
- Impaired eye movement
- Pain and swelling around the eye
- Confirmed orbital floor fracture from imaging tests (CT scan or X-ray)
Preparation
- Patients may need to fast for a specific time before the procedure, typically around 6-8 hours.
- Adjustments or temporary discontinuation of certain medications, especially blood thinners.
- Pre-operative imaging (CT scan) to evaluate the extent of the fracture.
- General health assessment and potential consultations with anesthesiology.
Procedure Description
- Anesthesia: General anesthesia is typically administered.
- Incision: A small incision is made inside the mouth above the upper teeth.
- Approach: The surgeon accesses the maxillary sinus by creating an opening in the anterior wall.
- Fracture Repair: The orbital floor fracture is visualized, and displaced bone fragments are repositioned or removed.
- Implants: Synthetic materials or bone grafts may be used to repair and stabilize the fracture.
- Closure: The incision inside the mouth is sutured closed.
- Monitoring: Post-operative monitoring for any immediate complications.
Tools and Equipment:
- Surgical instruments
- Imaging guidance tools
- Bone grafts or synthetic implants
- Anesthesia equipment
Duration
The procedure typically takes 1 to 2 hours.
Setting
Performed in a hospital operating room or specialized surgical center.
Personnel
- Orthopedic or maxillofacial surgeon
- Surgical assistants
- Operating room nurses
- Anesthesiologist
Risks and Complications
- Infection
- Bleeding
- Scarring
- Anesthesia reactions
- Persistent double vision
- Injuries to nearby structures, including nerves and blood vessels
- Recurrence of enophthalmos
Benefits
- Restoration of normal orbital anatomy
- Improvement in vision and eye movement
- Reduction in pain and swelling
- Prevention of long-term complications
Recovery
- Post-procedure care includes pain management, antibiotics to prevent infection, and possibly anti-inflammatory medications.
- Patients may need to avoid strenuous activities and nose-blowing for a few weeks.
- Follow-up appointments for monitoring healing and assessing the repair.
- Full recovery can take several weeks to months, with most people resuming normal activities within a few weeks.
Alternatives
- Non-surgical management with observation, if symptoms are mild
- Minimally invasive approaches
- Endoscopic repair approaches
- Pros and Cons: Non-surgical methods may not be effective for severe fractures, while minimally invasive and endoscopic methods might offer quicker recovery and fewer risks but may not be suitable for all types of fractures.
Patient Experience
- Patients may feel some discomfort and pressure around the incision site.
- Pain levels can be managed with prescribed medications.
- Temporary swelling and bruising around the eye and face.
- Early post-operative period involves restorative measures such as rest, ice applications, and avoiding facial trauma.
Pain management and comfort measures are emphasized to ensure a smooth recovery process.