Orbital reconstruction is a surgical procedure to repair the orbit, the bony socket that encloses and protects the eye. Damage to this complex structure can affect the position and function of the eye as well as the aesthetics of the face. This surgery aims to restore the structural integrity of the socket, ensuring the eyeball is properly supported and can move correctly. It involves repairing fractures, removing growths, or correcting malformations of the orbital bones.
The primary goals of this procedure are functional and aesthetic. Functionally, it seeks to preserve or restore vision and ensure the full range of eye movement. Aesthetically, it aims to return the eye to its normal position within the socket and restore the natural symmetry and contour of the face. Surgeons approach each case with the dual objectives of protecting the eye’s delicate structures and achieving a cosmetically sound result.
Common Causes for Surgery
The most frequent reason for orbital reconstruction is physical trauma. Incidents like motor vehicle accidents, sports-related impacts, and physical assaults can fracture the thin bones of the orbit. A common injury is a “blowout fracture,” where the floor or inner wall of the orbit shatters, potentially causing the eye to sink and entrapping the muscles that control eye movement. These fractures require repair to restore the proper volume of the eye socket and release entrapped tissues.
Tumors and cysts that develop within the orbit are another cause for surgery. These growths, whether benign or malignant, can expand and displace the eyeball, leading to vision problems and changes in appearance. The surgical procedure involves removing the mass while preserving the eye and its associated nerves and muscles. Following removal, reconstruction of any bone destroyed by the growth is often necessary to rebuild the orbital structure.
Certain medical conditions can also lead to changes in the orbital anatomy that require surgery. Graves’ disease, an autoimmune disorder affecting the thyroid, can cause severe inflammation of the tissues behind the eye, leading to thyroid eye disease. This inflammation can cause the eyes to bulge forward and alter the orbit’s structure over time. In advanced cases, orbital decompression surgery, a form of reconstruction, is performed to create more space in the socket and relieve pressure on the optic nerve.
Congenital conditions, or birth defects, can affect the normal development of the facial skeleton, including the orbits. Children may be born with malformed or incomplete orbital bones, which can impact vision and facial symmetry. Reconstructive surgery in these cases is aimed at correcting the structural abnormalities, allowing for proper growth of the eye and surrounding facial features.
The Surgical Process
Successful orbital reconstruction begins with pre-operative planning. Surgeons use advanced imaging, particularly computed tomography (CT) scans, to visualize the three-dimensional structure of the orbit and the precise nature of the damage. These scans allow for a detailed assessment of fracture patterns, bone loss, and the position of the eyeball and optic nerve. For complex cases, this imaging data can be used to create 3D-printed models of the patient’s skull, allowing the surgeon to simulate the procedure and pre-bend implants for a perfect fit.
The surgical procedure aims to restore the orbit’s natural shape and volume. To access the damaged area, surgeons use hidden incisions, such as inside the lower eyelid or in a natural skin crease, to minimize visible scarring. Through this opening, the surgeon elevates the soft tissues surrounding the eye to expose the fractured or damaged bone. The next step is to either reposition fractured bone fragments or, more commonly, cover the defect with an implant.
A variety of materials are available for reconstructing the orbital walls.
- Titanium mesh is a popular choice due to its strength, biocompatibility, and ability to be precisely contoured to the orbital shape.
- Porous polyethylene is another commonly used synthetic material with a porous structure, allowing the patient’s tissue to grow into it over time to help secure the implant.
- A bone graft may be used, taking a piece of bone from another part of the patient’s body, such as the skull or hip, to repair the defect.
- Custom-made implants fabricated from PEEK (polyetheretherketone) may be designed based on the patient’s CT scan for an exact anatomical fit for large defects.
Navigating the Recovery Phase
The initial 24 to 48 hours after orbital reconstruction involve swelling, bruising, and some discomfort around the eye. Vision may be temporarily blurry from swelling or lubricating ointments used during surgery. Pain is managed with prescribed medication. Patients are advised to rest with their head elevated to minimize swelling, and cold compresses are often recommended for the first two days.
In the first few weeks following the procedure, following post-operative instructions is important for a smooth recovery. Patients are instructed to avoid strenuous activities, heavy lifting, and bending over to prevent an increase in pressure around the surgical site. It is also common to be told to avoid blowing one’s nose, as this can force air from the sinuses into the orbit. The surgeon may prescribe antibiotic or steroid eye drops to prevent infection and reduce inflammation.
Follow-up care is a component of the recovery process. A post-operative appointment is scheduled within the first week to assess healing, check vision, and ensure the implant is stable. Additional follow-up visits will monitor the long-term healing process. The surgeon will advise when it is safe to return to normal activities, which can range from a few weeks to a couple of months depending on the extent of the surgery.
Surgical Outcomes and Potential Risks
The goals of orbital reconstruction are to restore function and appearance. A successful surgery should result in the eye being in its proper position, which often corrects issues like double vision (diplopia) and a sunken appearance (enophthalmos). The procedure also serves to protect the eyeball and restore the normal symmetrical appearance of the face. Many patients experience significant improvement in their quality of life, with high rates of patient satisfaction.
Despite the high success rate, orbital reconstruction carries potential risks. Infection at the surgical site is a possibility, though it is mitigated by sterile surgical techniques and antibiotics. Persistent double vision or numbness in the cheek, lip, and teeth can occur from damage to the infraorbital nerve, which runs along the floor of the orbit. While this numbness is often temporary, it can be permanent in some cases.
Rarer complications can include issues with the implant, such as misplacement, which may require a second surgery to correct. In very rare instances, there is a risk of vision loss from swelling or bleeding behind the eye (retrobulbar hematoma) that compresses the optic nerve. Patients should have a thorough discussion with their surgeon about these potential risks before proceeding with the surgery.