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.
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