32 Medial Orbital Blowout Fracture Repair

Seanna Grob, Emily Charlson, and Jeremiah P. Tao

Summary

Medial orbital blowout fractures are a common sequela of blunt trauma and can be isolated or in combination with other fractures—namely, the orbital floor. Composed in part of the very thin lamina papyracea, the medial wall is most susceptible to fracture. Emergent repair is indicated for muscle entrapment which is rare along the medial wall. For all other cases, surgical invention or not is based on clinical exam findings once the acute soft-tissue swelling has subsided. Repair should be considered for persistent double vision/strabismus or to forestall disfiguring enophthalmos. Transcaruncular or transcutaneous approaches can be used to access the medial orbital wall. When an orbital floor fracture is also present, an additional swinging eyelid transconjunctival approach to the orbital floor can be performed. Combined medial wall and floor fractures can often be repaired with a single implant in a “wraparound” fashion. Complications of medial wall repair include lacrimal system damage, lower eyelid malposition, optic nerve compression, and globe restriction. With adequate planning and good surgical technique, outcomes after medial orbital wall blowout fracture repair are generally favorable with minimal visible scars.

Key words

orbital fracture - orbital fracture repair - medial orbital wall fracture - combined medial and floor orbital fracture - blowout fracture - transcaruncular approach - swinging eyelid approach - wraparound technique