Late Management of Orbital Fracture. A Case Report.

Abstract

Introduction: Orbital fractures are among the most complex injuries managed by maxillofacial surgeons. While delayed surgical intervention can allow edema to subside and facilitate accurate anatomical assessment, it may also increase the risk of permanent complications, such as soft tissue fibrosis and impaired ocular motility.

Case Presentation: We report the case of a 56-year-old male who sustained a left orbital fracture in a motor vehicle accident two months prior. The patient presented with persistent diplopia, hypoglobus, and telecanthus. CT imaging revealed displacement of both the superior and inferior orbital rims, along with inferior displacement of the orbital floor. Surgical correction was performed via a multi-approach technique: frontoethmoidal and upper eyelid crease incisions, intraoral maxillary vestibular access, and infraorbital incision. Reconstruction involved osteotomy and repositioning of displaced orbital segments, using titanium microplates and mesh pre-adapted to a 3D stereolithographic model for precision. The duction test confirmed restored ocular mobility intraoperatively.

Results: Two weeks postoperatively, the patient reported resolution of diplopia and demonstrated full, symmetrical ocular motility. This successful outcome, with no further complications observed, underscores the effectiveness of our surgical approach.

Conclusion: This case underscores the importance of early diagnosis and timely surgical repair in achieving optimal functional and aesthetic recovery in orbital trauma cases. Even with a late intervention, favorable outcomes can be achieved through meticulous anatomical reconstruction and advanced techniques such as stereolithographic modeling.