Name of the Procedure:

Orbitotomy with Bone Flap or Window, Lateral Approach (e.g., Kroenlein); with Removal of Foreign Body

Summary

Orbitotomy with a bone flap or window, utilizing a lateral approach (also known as Kroenlein orbitotomy), is a surgical procedure to access and remove a foreign body from the eye socket (orbit). This approach involves creating an opening in the bone surrounding the eye to safely access and extract the foreign object.

Purpose

This procedure aims to remove foreign bodies that are lodged within the orbit, which may potentially cause damage to the eye and surrounding structures. The goals are to prevent further injury, alleviate symptoms such as pain and vision impairment, and maintain or restore eye function.

Indications

• Presence of a foreign body within the eye socket that cannot be removed through less invasive methods.
• Symptoms such as pain, swelling, impaired vision, or double vision resulting from the foreign body.
• Risk of infection or damage to the eye and adjacent structures due to the foreign material.

Preparation

• Patients may be instructed to fast for 8-12 hours before the procedure.
• Medication adjustments, such as discontinuing blood thinners, may be necessary.
• Diagnostic imaging (e.g., X-ray, CT scan, MRI) to locate the foreign body and plan the surgical approach.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the skin overlying the lateral (side) aspect of the orbit.
3. A bone flap or window is created in the lateral orbital wall to gain access to the orbit.
4. The foreign body is carefully located and removed using specialized instruments.
5. The bone flap is repositioned or the bone window is closed, and the incision is sutured.
6. A dressing is applied to the surgical site.

Duration

The procedure typically takes 1-3 hours, depending on the complexity and location of the foreign body.

Setting

Performed in a hospital or surgical center, typically within an operating room equipped for ophthalmic surgery.

Personnel

• Ophthalmic surgeon or oculoplastic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to the eye or surrounding structures
• Scarring
• Anesthesia-related risks
• Vision changes or loss

Benefits

• Safe removal of the foreign body
• Alleviated pain and discomfort
• Prevention of further damage to the eye
• Improved or maintained vision and eye function

Recovery

• Post-procedure care includes administering antibiotics and pain medication.
• The patient will have a follow-up appointment to monitor healing.
• Recovery time varies, but patients can generally resume normal activities within 2-4 weeks with some restrictions on strenuous activities.

Alternatives

• Non-surgical removal of the foreign body if feasible.
• Observation if the foreign body poses no immediate risk.
• Endoscopic orbitotomy for certain types of foreign bodies.
• Each alternative comes with different risks and benefits; surgery is often chosen when the risk of complications from the foreign body outweighs those of the surgical procedure.

Patient Experience

• The procedure itself is performed under general anesthesia, ensuring that the patient is asleep and pain-free.
• Post-surgery, the patient may experience swelling, bruising, and mild pain around the eye, managed with medication.
• Clear post-operative instructions are provided to aid in recovery and minimize complications.