Repair of orbital fracture: the antral balloon with implantable reservoir technique

Orbital Blowout Fracture With Globe Displacement Into the Maxillary Sinus: A Case Report and Literature Review

Blunt trauma in the orbital region often results in fracture of 1 or more bone walls resulting in alteration of the orbital volume with the potential for visual sequelae. This study reports a rare case of displacement of the eyeball into the maxillary sinus after blunt trauma as well as its initial management, treatment, and clinical follow-up. Victims of eyeball displacement have a poor visual prognosis. Even if the patient has already been diagnosed with amaurosis on arrival to the hospital, all measures for rapid eye repositioning and reconstruction of the orbital cavity must be instituted, as well as appropriate clinical and pharmacologic management to avoid further complications.

Correction of Late Posttraumatic Enophthalmos Using an Antral Balloon

Enophthalmos is the posterior displacement of the ocular globe within the bony orbit. Correction of late posttraumatic enophthalmos is one of the most challenging surgical procedures. We have performed a corrective procedure for late enophthalmos using an antral balloon, with or without minimal bone grafting. All orbital contents were separated from the bone fragments, infraorbital nerve, and mucosa of the maxillary antrum. The remaining orbital floor was fractured by the surgeon's digital pressure from the maxillary antrum. The antral balloon was placed in the maxillary antrum and inflated under direct vision from inside the orbit. After a consolidation period, the patient underwent antral balloon removal. A total of 5 patients underwent repair of late enophthalmos using this antral balloon technique. The median time from initial injury was 14 months (range, 6-90 months). The median antral balloon placement duration was 76 days (range, 53-106 days). Satisfactory symmetries were achieved in 4 patients. Mild residual enophthalmos remained in 1 patient, who had an orbital framework deformity and was missing the entire orbital bony floor preoperatively and who required simultaneous bone grafting. The ideal indication for our technique was the need for orbital floor reconstruction, without an orbital framework deformity. This technique could avoid autogenous bone grafting or permanent alloplastic implantation, which may cause a foreign body reaction, chronic inflammation, and migration. We believe that our new technique is one of the least invasive corrective procedures for late posttraumatic enophthalmos.