![]() ![]() The wound closure was performed in 2-layer fashion approximating the galea with 2-0 Vicryl and the skin with staples. We then went back to the skull area and obtained hemostasis, irrigated and placed a 7 mm Jackson-Pratt drain. It sat in nicely and orbital contents were then allowed to rest upon it. At any rate, we contoured the bone graft, fit in nicely. We shortened it somewhat and we put a groove in it in the apical area to accommodate the infraorbital nerve, which would be impinged upon had we not made this groove. We then went back to the orbital floor and the contour of the bone graft to fit nicely in the orbital floor. Once we got to the diploic space, we then harvested the split calvarial bone graft with the osteotome it came out nicely. We did this completely circumferentially around this marked out area. We burred down to the diploic space first. The bur was used to harvest the split calvarial graft. It was 3 cm in length and the anterior widest portion of it was about 2.5 cm and it tapered down to the apex as it went anterior to posterior. We then exposed the area and drew out the bone graft that we wanted to harvest. Dissection was then carried through the subcutaneous tissue, galea down to the underlying periosteum of bone in this area. We then went ahead and went to the left temporoparietal region and made an incision to the scalp. The defect was obvious although, orbital contents were now taken out of the defect into the orbit proper. Medial, lateral, anterior ledges were well defined, and as we dissected further back, posterior ledge was then defined. We then dissected all the way back posteriorly following the posterior ledge. The inferior orbital nerve was identified and kept intact at all times going along the orbital floor. We very carefully then teased the scar tissue around the fat into the orbit proper. As we dissected into the eye, the fracture was noted with the herniated orbital contents into the maxillary sinus. We then took the Joseph periosteal elevator and dissected into the eye. Electrocautery was used to incise the periosteum and the inferior orbital rim. Dissection was carried down to the inferior orbital rim. Dissection was then carried down to the septum orbitale. The skin flap was elevated exposing the muscle. A subciliary incision was made going lateral to medial. What we did first was to make the subciliary incision. The patient had been prepped and draped in usual sterile manner. We infiltrated into the lower eyelid on the left side as well as the left temporoparietal region, where the bone graft would be harvested from. The patient was then repositioned appropriate, prepped and draped in usual sterile manner. During surgery, there was a lot of scarring, adhesions of the fatty tissue in the maxillary sinus.ĭESCRIPTION OF OPERATION: The patient was brought into the operating suite and given general endotracheal anesthesia for exploration and reconstruction of left orbital floor blowout fracture with split calvarial bone graft. Again, his diplopia was in an upward and lateral gaze and not on straight gaze. The patient did have some numbness in the left infraorbital nerve distribution. OPERATIVE FINDINGS: Clinically showed the patient with enophthalmos it was significant. The patient understood and wanted to proceed with exploration and reconstruction of left orbital floor blowout fracture with split calvarial bone graft. The patient was explained the risks, complications, benefits, alternatives, including the risks of bleeding, infection, scarring, injury to nerve. The patient was told of the options, and the patient agreed to go forward with surgery. He also complained of some numbness in the left infraorbital nerve distribution. He did not have any straight forward gaze diplopia. The patient came in complaining of pain to his eye, in addition some diplopia on upward and lateral gaze. The patient sustained a fracture in that area. INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who was apparently assaulted and sustained a blow to the eye region. OPERATION PERFORMED: Exploration and reconstruction of left orbital floor blowout fracture with split calvarial bone graft. POSTOPERATIVE DIAGNOSIS: Left old orbital floor blowout fracture. PREOPERATIVE DIAGNOSIS: Left old orbital floor blowout fracture. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |