RESUMO
The degree of resolution of diplopia after repair of a blow-out fracture of the orbital floor varies and depends on many factors. We present six patients, each of whom had extensive fractures of the floor of the orbit that extended posteriorly to its anatomical limit. The mean (range) time for the resolution of diplopia after reconstruction was 4.4 (1-7) months. We think that its slow resolution in these patients may require preoperative counselling, and also the postoperative management of patients with extensive disruptions of the floor of the orbit posterior to the anterior limit of the inferior orbital fissure (within the deep orbit) must be carefully planned.
Assuntos
Diplopia/terapia , Fraturas Orbitárias/cirurgia , Adulto , Idoso , Placas Ósseas , Transplante Ósseo , Enoftalmia/etiologia , Exotropia/etiologia , Movimentos Oculares/fisiologia , Seguimentos , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Estrabismo/etiologia , Tomografia Computadorizada por Raios X , Transplante Autólogo , Fraturas Zigomáticas/cirurgiaRESUMO
Dissection deep within the orbit is a cause for concern to surgeons because of the perceived risks of injuring critical structures such as the contents of the superior orbital fissure and the optic nerve. Although "safe distances" (those distances within which it is considered safe to dissect within the orbit) have been described, these are of limited value if the orbit is severely disrupted or is congenitally shallow. In addition, traumatic defects in the orbital floor, in particular, often extend beyond these distances. Reliable landmarks based on the relations between anatomical structures within the orbit, rather than absolute distances, are described that permit safe dissection within the orbit. We present the concept of the deep orbit and describe its relevance to repair of injuries.