What you need to know about:

Orbital Fracture Treatment

Fast Fact

83%

Worth It Rating

Average Cost:

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Recovery Period:

3 weeks

Permanence:

Permanent

177

Doctors

Time it takes:

Depends on patient condition

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Anesthetize:

General Anesthesia

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Overview of

Orbital Fracture Treatment

in Thailand

An orbital fracture, also known as an orbital blowout fracture, is frequently found in patients who experience trauma to their faces or skulls. The impact may be mild or severe, causing the eye socket (the bony cup that surrounds and protects the eye) to become fractured or even damaging the eye itself. The extent of the damage depends on the intensity of the trauma and the direction of the impact to the bone and eye. Injury can occur to the globe (eyeball), eyelid, lacrimal system, bones around the eye, sinuses, and/or the brain. Thus, it is very important to carefully examine the patient’s eyes after an accident to understand the full extent of the injuries. Sometimes after an accident it is difficult to assess the extent of injury because the area around the affected eye may be bruised and swollen (eyelid and orbital edema). The doctor will need to wait for the swelling to go down before they can properly examine the eye. This should be done by a specialist, such as an oculoplastic specialist (ophthalmic plastic and reconstructive surgery). There are 3 types of orbital fractures: 1. Blowout Fracture – The most commonly encountered, a blowout fracture occurs in the eye socket along the floor or inner wall near the nose and is often due to something hitting the eye with force, like a tennis ball or racquetball. These fractures may be asymptomatic and can be observed or cause problems with double vision, or a change in the position of the eyeball, and require surgical repair. 2. Orbital Rim Fracture – These fractures are located on the outer edges of the eye socket and require a large amount of force to inflict. Orbital rim fractures are often the result of car accidents, accompanying other injuries to the head and face, and may present as an irregular contour along the edge of the eye socket. 3. Compound Fractures – Trauma to the midface may result in a combination of fractures including the orbital rim, floor, and cheek, and may be referred to as a tripod or ZMC (zygomaticomaxillary complex) fracture. This may affect both the eye socket and the maxilla or upper jaw, resulting in abnormalities in biting or chewing. Other compound fracture associations include the bones of the nose, calvarium (chamber that contains the brain), and skull base.

Goals of

Orbital Fracture Treatment

The purpose of this procedure is to correct abnormality and return normal function. To minimize the impact to vision. To minimize the impact to other organs within the eye.

Price of

Orbital Fracture Treatment

Average Cost

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Price Range

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Pros and cons of

Orbital Fracture Treatment

Pros

-Depending on the type of injury that you may have sustained, your doctor will decide on the best approach to help treat your condition. Your doctor will provide you details regarding the advantages and disadvantages of each procedure.

Cons

N/A

How it works:

Orbital Fracture Treatment

There are three to four surgical approaches, but the most popular are: 1.Subciliary approach, under the eye 2.Transconjunctival approach, as seen in (A) of the second image on the right. The advantage to this approach is there is no visible scarring, but it also means limited visibility for the doctor, which may require extension of the incision (as in B and C). 3.Fixation Materials for Orbital Fracture Autogenous material, which is the patient’s own bone, such as cartilage from the rib or nasal septum or bone from the skull, hip, rib, or chin. Advantage: Low risk of infection and rejection Disadvantage: Additional surgery is necessary, which means more time and more pain Allogenic material, which is donor bone/material, such as lyophilized dura/cartilage or fascia lata. This option is rarely used due to risk of cross contamination. Alloplastic material, which can be divided into two categories: Non-resorbable materials, such as titanium plate, polyethylene polymer, and hydroxyapatite (artificial bone) Resorbable materials, such as polydioxanone (PDS) polymer, polyglactin polymer (Vicryl), and Lactasorb (combination of polylactic and polyglycolic) Xenograft, which is material from animals, such as collagen; rarely used due to the risk of infection and rejection. Factors for Choosing Fixation Material The size of the fracture: A small fracture (less than 5 millimeters) may require a soft material like polydioxanone (PDS) polymer while a bigger fracture may require Lactosorb; a very big fracture/enphthalmos may require a stronger material like titanium plates or bone from the skull or hip. Patient’s preference, such as whether or not they would like to use their own cartilage/bone. Experience and expertise (with the material) of the doctor.

Preparation before

Orbital Fracture Treatment

Pre - treatment

A thorough examination by an ophthalmologist is necessary to rule out any other injuries or conditions, such as hyphema (blood in the anterior chamber of the eye), retinal detachment, vitreous hemorrhage, lens subluxation, or fractures of the skull or facial bones. Specific equipment is required to diagnose and rule out each condition. Imaging studies. A computed tomography (CT) scan may be necessary to check for injury to nearby muscle and tissue.

Recovery after

Orbital Fracture Treatment

Post - treatment

After the procedure you will need to stay in the hospital so the doctor can monitor and assess your vision. You will be prescribed pain medication and antibiotics. Please use the eye drops as instructed and take all medication prescribed. Please keep all follow-up appointments. Do not let the incisions come into contact with water for at least one month after the procedure.

Risks & side effects

-Loss of vision

-Bleeding

-Permanent enophthalmos

-Inflammation

-Infection

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Complications can be avoided by choosing the appropriate method and technique for surgery and the right fixation material.

FAQs:

Orbital Fracture Treatment

What symptoms are indicative of an orbital fracture post injury?

-Numbness in the cheek. -Double vision. -Swelling and bruising of the eyelid. -Difficulty opening the eye or inability to open the eye completely due to muscles being compressed by the fractured bone. After the swelling goes down, the eyeball appears smaller than normal or looks “collapsed.”

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What are the indications for surgery?

Many orbital fractures do not lead to enophthalmos, diplopia or ocular motility dysfunction so the decision to observe a fracture or proceed with surgery is based on the clinical exam findings, orbital imaging and assessment of the risk and benefit of either option. If there is a clear sign of muscle entrapment, surgery should be performed within 48 hours to prevent the death of tissue that is essential for the normal functioning of the eye. If symptoms occur, such as cheek numbness, double vision, blurry vision, uneven eyes (the affected eye looks lower than the healthy eye), difficulty moving the eye around, or the affected eye is more “sunken” or if computed tomography (CT) scans show that the eye tissue has been displaced into the sinus cavity or has become trapped, treatment can be delayed for no more than two weeks. This is because scar tissue or adhesions may form, making surgery more difficult and, in the long-term, causing the affected eye to become sunken (enophthalmos).

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What are the travel recommendations?

Before the Procedure Please plan to stay in Thailand for at least one week through the duration of treatment. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure. You will undergo a health screening when convenient for you before the procedure as the procedure is done using general anesthesia. You will likely need to fast before the health screening. You will be given detailed instructions by your medical team. After the Procedure The doctor will schedule a follow-up appointment for the day after the procedure. If you have no abnormal symptoms after the procedure you can usually return to your home country. The final decision will depend on your doctor’s recommendation. After the follow-up appointment the day after the procedure you will need to see your doctor one month after the procedure, three months after the procedure, and six months after the procedure. If you cannot return to Thailand for these appointments, please see an ophthalmologist in your home country.

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What is the likelihood of success?

The success of this procedure depends on the injury and timely and correct medical attention from an ophthalmologist when the injury/trauma occurs. What if the procedure is not performed? Complications can occur from death of tissue around the eye.

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