Rhytidectomy: Evolution and Current Concepts

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???? 2003
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Orbital Blowout Fracture
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• Frontal, Zygomatic, Ethmoid, Lacrimal, Maxilla,
  Palatal, Sphenoid

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• ??? ????? superomedial ?????

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Blow Out Fracture

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• Pure Vs Non-Pure Blow-Out Fractures
• Hydraulic Vs Buckling Theory

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Orbital Blowout Fracture

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• Enophthalmos
• Inferior Displacement
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• ATLS
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• ???????
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• ????? ????? ???? (rim)
• ??? ???? ???? (enophthalmus)

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Hyphema

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• Subconjunctival ecchymosis

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Forced Duction Testing
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• CT ????? ?????? ??????? ????? ??????

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• stable to unstable
• Use occlusion as guide
• mandible, zygoma, palate, midface, before orbit
  and NOE

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• Persistent diplopia with positive forced duction
• Obvious enophthalmos
• Comminuted orbital rim by CT
• gt50 floor disruption by CT
• Combined floor/medial wall defects by CT
• Fracture of zygoma body by CT
• Blow-in fx with exophthalmos by PE or CT

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• Only seeing eye
• Eye injury (hyphema, retinal tear, globe
  perforation)
• Other injuries, medical instability, multi-trauma

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• ????? ???????? 7-10 ????

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• A -- subciliary
• B -- lower eyelid
• C -- infraorbital

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Subciliary Approach
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Transconjunctival Approach
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Transconjunctival Approach

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Lateral Canthotomy and Cantholysis

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Orbital Floor Materials

• Marlex mesh
• needs 360 degree support
• better for concave anterior floor only
• Medpor
• needs medial/ lateral support
• can use for anterior/posterior defect
• Calvarial bone graft
• Titanium mesh

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Orbital Floor Bone Grafting
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Orbital Metallic Mesh
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Lateral Brow Incision
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• Subciliary
• Transconjunctival
• Medial incision
• Coronal approach

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Coronal Approach
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Orbital Roof Repair

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Orbital Apex Injuries

• Optic Canal Injury
• Orbital Apex Syndrome
• Intracanalicular Injury
• Intraorbital Injury

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• ?????????- malocclusion- ???????? ?? ?????-
  ???? ?????- ????? ???? ???? ?????- ?????
  ????????

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• Bioresorbable plates
• Intraoperative CT
• 3-D CT reconstruction
• Endoscopic assistance

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