ORBITAL RECONSTRUCTION

The orbit is the part of the facial skeleton that contains the eye. Apart from the eye the contents of the orbit include fatty tissue and the muscles that move the eye.

Despite the protection provided to the eye by the surrounding bone and the eyelids, it is frequently subject to injuries, and in cases of violent impact the orbit itself may be fractured.

The consequences of an injury to the orbit may include deformity, double vision (diplopia) because of injury to the muscles that move the eye or displacement of the globe itself, or even loss of vision.

In orbital fractures without loss of the eye, it is important to achieve a satisfactory reduction of the fractures by means of an operation, and to hold the fractured bones in their normal position with fine wires or small plates and screws made of titanium. It is also necessary to ensure that no defects remain in any of the walls of the orbit that would allow orbital contents to be displaced outside the orbit boundaries.

If the eye is injured and vision is lost permanently, normal or near – normal appearance can be restored by the construction of an “artificial eye”. The “artificial eye” of course cannot restore vision. It is like a large contact lens that looks exactly like the other, normal eye. It should be custom made by an expert certified ocularist. In some instances the artificial eye may even be capable of movement.

In cases of severe injury, involving bone as well as soft tissues, the general principles of trauma reconstruction apply. The best chance for an optimal result is afforded during the initial repair, immediately following the injury.

Secondary orbital reconstruction is a very complex undertaking, requiring a series of procedures. The skeleton has to be reconstructed first, by replacing missing bone with bone grafts from other parts of the body, and by restoring displaced bone fragments to their normal position whenever possible, after, so to speak, recreating the fracture surgically. Reconstruction of the soft tissues and particularly the eyelids is of paramount importance. The presence of excessive scarring will reduce plasticity and movement and will preclude any possibility of a pleasing appearance.

  The orbital contents have to be restored next. If the eye has been lost and the volume of the soft tissues in the orbit is reduced, a normal volume of the orbital contents has to be restored by insertion of an orbital implant. This is a sphere made of hydroxyapatite (coral), or of a different synthetic material. Unless this is done, it is not possible to construct an “artificial eye” prosthesis. The prosthesis must be thin and light of weight, or it will predictably deform the lower eyelid and alter the form of the free eyelid border.

Coral implant                            Plastic (PMMA) implant

  There are many fine details that will determine the final result. A peg may be inserted in the hydroxyapatite implant, which by means of a “ball and socket” articulation to the eye prosthesis can, under special circumstances, provide movement to the prosthesis.

  Finally we wish to emphasize that planning of each case has to be individualized and only a detailed discussion with the members of the craniofacial team can provide one with the specific details necessary for his or her treatment.