This is a retrospective review of 13 patients with sub-optimal outcomes following primary orbital fracture repairs who underwent revision surgery. All had fractures of the orbital floor, with four involving other orbital walls, and six also involving other facial bones. Interestingly, only nine of the 13 had previous implants, all of which were removed. All patients had new implants usually with porous polyethylene embedded with titanium mesh. Revision surgery was performed at a median of seven months after primary repair. The indications were enophthalmos (12), hypoglobus (10), restricted motility (12), superior sulcus deformity (nine), cheek numbness (four), severe pain (two) and compressive optic neuropathy (one). Six of the nine cases with implants had inferior displacement of the floor implant, three of which were more than 1cm below the posterior anatomical floor. Two cases had superior displacement, one of whom had impingement on the optic nerve. Revision surgery was effective with statistically significant reductions of enophthalmos (mean 3.4mm) and hypoglobus (mean 2.9mm). The superior sulcus deformity resolved in all nine cases. Three patients required strabismus surgery, and overall all 12 with restricted motility improved and five had complete resolution. The visual acuity in the patient with optic neuropathy improved from 20/80 to 20/30. There were no cases of new or worse infraorbital nerve hypoaesthesia. Twelve of 13 patients were either satisfied or very satisfied with the outcome. Although limited by small numbers this review shows that good results are possible in revision surgery and stresses the importance of correct implant placement and fixation during both revision and primary repair. 

Secondary orbital reconstruction in patients with prior orbital fracture repair.
Kim JS, Lee BW, Scawn RL, Korn BS, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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