Dr.Shilpa Taneja Mittal, Dr.Debraj Shome
A young female patient presented to us with right eye enophthalmos, hypotropia and pain in upper incisiors, following trauma to right side of her face. CT scan revealed impure type of right sided orbital floor fracture.We managed the patient using hidden trans conjunctival incision. Intraoperatively, we could visualize fracture line running through the infra orbital foramen extending to the place where infraorbital nerve was seen exiting through the orbital floor.
This is the first reported case in which titanium mesh was used; split in two halves to incorporate the infra orbital nerve. A porous polyethylene sheet of 1mm thickness was then placed on top of titanium mesh to take care of enophthalmos and to ensure that hypotropia was completely cured. Preservation & replacement of normal anatomical structures is important during orbitomaxillary fracture repairs, not just for regaining the functional ocular motility and cosmesis but, also to save the patient from referred neurogenic pain.