Orbital Fractures

  • Simon Holmes
  • Michael Perry
  • Joe McQuillan
  • Steve White


This highly illustrated chapter discusses the initial assessment, investigations and management of fractures of the orbit. Numerous case examples are shown, step-by step, illustrating the access and surgical repair of most fractures commonly seen. Technical advances and current areas of controversy are also discussed.


Extraocular Muscle Medial Wall Orbital Floor Optic Canal Infraorbital Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Selected Reading

  1. Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs. subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol. 1993;119:1000–7.CrossRefGoogle Scholar
  2. Buchel P, Rahal A, Seto I, Iizuka T. Reconstruction of orbital floor fracture with polyglactin 910/polydioxanon patch (Ethisorb): a retrospective study. J Oral Maxillofac Surg. 2005;63:646–50.PubMedCrossRefGoogle Scholar
  3. Burm JS. Internal fixation in trapdoor-type orbital blowout fracture. Plast Reconstr Surg. 2005;116:962–70.PubMedCrossRefGoogle Scholar
  4. Burm JS, Chung CH, Oh SJ. Pure orbital blowout fracture, new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg. 1999;103:1839–49.PubMedCrossRefGoogle Scholar
  5. Burnstine MA. Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol. 2003;14:236–40.PubMedCrossRefGoogle Scholar
  6. Castellani A, Negrini S, Zanetti U. Treatment of orbital floor blowout fractures with conchal auricular cartilage graft: a report on 14 cases. J Oral Maxillofac Surg. 2002;60:1413–7.PubMedCrossRefGoogle Scholar
  7. Chang EL, Bernardino CR. Update on orbital trauma. Curr Opin Ophthalmol. 2004;15:411–5.PubMedCrossRefGoogle Scholar
  8. Cheong EC, Chen CT, Chen YR. Endoscopic management of orbital floor fractures. Facial Plast Surg. 2009;25:8–16.PubMedCrossRefGoogle Scholar
  9. Converse JM, Firmin F, Wood-Smith D, Friedland JA. The conjunctival approach in orbital fractures. Plast Reconstr Surg. 1973;52:656–7.PubMedCrossRefGoogle Scholar
  10. Cunningham LL, Peterson GP, Haug RH. The relationship between enophthalmos, linear displacement, and volume change in experimentally recreated orbital fractures. J Oral Maxillofac Surg. 2005;63:1169–73.PubMedCrossRefGoogle Scholar
  11. Ellis III E, Tan Y. Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg. 2003;61:442–53.PubMedCrossRefGoogle Scholar
  12. Evans BT, Mourouzis C. Lateral orbitotomy: a useful technique in the management of severe traumatic disruption of the lateral orbital skeleton. Int J Oral Maxillofac Surg. 2009;38:984–7.PubMedCrossRefGoogle Scholar
  13. Forrest CR, Lata AC, Marcuzin DW, Bailey MH. The role of orbital ultrasound in the diagnosis of orbital fractures. Plast Reconstr Surg. 1993;92:28–34.PubMedCrossRefGoogle Scholar
  14. Francis DO, Kaufman R, Yueh B, Mock C, Nathens AB. Air bag-induced orbital blow-out fractures. Laryngoscope. 2006;116:1966–72.PubMedCrossRefGoogle Scholar
  15. Fujino T, Sugimoto C, Tajima S, Moribe Y, Sato TB. Mechanism of orbital blowout fracture: II. Analysis by high speed camera in two dimensional eye model. Keio J Med. 1974;23:115–24.PubMedCrossRefGoogle Scholar
  16. Gellrich NC, Schramm A, Hammer B, Schmelzeisen R. The value of computer-aided planning and intraoperative navigation in orbital reconstruction. Int J Oral Maxillofac Surg. 1999;28 Suppl 1:52.CrossRefGoogle Scholar
  17. Goldberg RA, Garbutt M, Shorr N. Oculoplastic uses of cranial bone grafts. Ophthalmic Surg. 1993;24:190–6.PubMedGoogle Scholar
  18. Habal MB. Bone grafting the orbital floor for posttraumatic defects. J Craniofac Surg. 1992;3:175–80.PubMedCrossRefGoogle Scholar
  19. Hayter JP, Sugar AW. An orbital observation chart. Br J Oral Maxillofac Surg. 1991;29:77–9.PubMedCrossRefGoogle Scholar
  20. He D, Blomquist PH, Ellis III E. Association between ocular injuries and internal orbital fractures. J Oral Maxillofac Surg. 2007;65:713–20.PubMedCrossRefGoogle Scholar
  21. Hosal BM, Beatty RL. Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit. 2012;21:27–33.CrossRefGoogle Scholar
  22. Hundepool AC, Willemsen MAP, Koudstaal MJ, van der Wal KG. Open reduction versus endoscopically controlled reconstruction of orbital floor fractures: a retrospective analysis. Int J Oral Maxillofac Surg. 2012;41:489–93.PubMedCrossRefGoogle Scholar
  23. Jank S, Emshoff R, Schuchter B, Strobl H, Brandlmaier I, Norer B. Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:16–22.PubMedCrossRefGoogle Scholar
  24. Jank S, Emshoff R, Etzelsdorfer M, Strobl H, Nicasi A, Norer B. The diagnostic value of ultrasonography in the detection of orbital floor fractures with a curved array transducer. Int J Oral Maxillofac Surg. 2004;33:13–8.PubMedCrossRefGoogle Scholar
  25. Jin HR, Yeon JY, Shin SO, Choi YS, Lee DW. Endoscopic versus external repair of orbital blowout fractures. Otolaryngol Head Neck Surg. 2007;136:38–44.PubMedCrossRefGoogle Scholar
  26. Johnson PE, Raftopoulos I. In situ splitting of a rib graft for reconstruction of the orbital floor. Plast Reconstr Surg. 1999;103:1709–11.PubMedCrossRefGoogle Scholar
  27. Kelly CP, Cohen AJ, Yavuzer R, Jackson IT. Cranial bone grafting for orbital reconstruction: is it still the best? J Craniofac Surg. 2005;16:181–5.PubMedCrossRefGoogle Scholar
  28. Kontio R. Treatment of orbital fractures: the case for reconstruction with autogenous bone. J Oral Maxillofac Surg. 2004;7:863–8.CrossRefGoogle Scholar
  29. Kontio RK, Laine P, Salo A, Paukku P, Lindqvist C, Suuronen R. Reconstruction of internal orbital wall fracture with iliac crest free bone graft: clinical, computed tomography, and magnetic resonance imaging follow-up study. Plast Reconstr Surg. 2006;118:1365–75.PubMedCrossRefGoogle Scholar
  30. Krishnan V, Johnson JV. Orbital floor reconstruction with autogenous mandibular symphyseal bone grafts. J Oral Maxillofac Surg. 1997;55:327–30.PubMedCrossRefGoogle Scholar
  31. Lai A, Gliklich RE, Rubin PA. Repair of blow-out fractures with nasoseptal cartilage. Laryngoscope. 1998;5:645–50.CrossRefGoogle Scholar
  32. Lal D, Stankiewicz JA. Endoscopic optic nerve decompression. Oper Tech Otolaryngol. 2009;20:96–100.CrossRefGoogle Scholar
  33. Lee S, Maronian N, Most SP, Most SP, Whipple ME, McCulloch TM, et al. Porous high-density polyethylene for orbital reconstruction. Arch Otolaryngol Head Neck Surg. 2005;131:446–50.PubMedCrossRefGoogle Scholar
  34. Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L. Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg. 2002;13:726–38.PubMedCrossRefGoogle Scholar
  35. Mathog RH. Repair of orbital floor fractures with bioactive glass implants. J Oral Maxillofac Surg. 2001;59:1390–5.CrossRefGoogle Scholar
  36. Metzger MC, Schön R, Weyer N, Rafii A. Anatomical 3-dimensional pre-bent titanium implant for orbital floor fractures. Ophthalmology. 2006;113:1863–8.PubMedCrossRefGoogle Scholar
  37. Nagasao T, Miyamoto J, Nagasao M, Ogata H, Kaneko T, Tamaki T, Nakajima T. The effect of striking angle on the buckling mechanism in blowout fracture. Plast Reconstr Surg. 2006;117:2373–80; discussion 2381.PubMedCrossRefGoogle Scholar
  38. Nagasao T, Hikosaka M, Morotomi T, Nagasao M, Ogawa K, Nakajima T. Analysis of the orbital floor morphology. J Craniomaxillofac Surg. 2007;35:112–9.PubMedCrossRefGoogle Scholar
  39. Nolasco FP, Mathog RH. Medial orbital wall fractures: classification and clinical profile. Otolaryngol Head Neck Surg. 1995;112:549–56.PubMedGoogle Scholar
  40. O’Regan MB, Macleod SPR. Miniantrostomy for the reduction of fractures in the orbital floor. Br J Oral Maxillofac Surg. 2000;38:191–2.PubMedCrossRefGoogle Scholar
  41. Parsons GS, Mathog RH. Orbital wall and volume relationships. Arch Otolaryngol Head Neck Surg. 1988;114:743–7.PubMedCrossRefGoogle Scholar
  42. Patel PC, Sobota BT, Patel NM, Green JS, Millman B. Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases. J Craniomaxillofac Trauma. 1998;4:17–21.PubMedGoogle Scholar
  43. Persons BL, Wong GB. Transantral endoscopic orbital floor repair using resorbable plate. J Craniofac Surg. 2002;13:483–8.PubMedCrossRefGoogle Scholar
  44. Potter JK, Ellis E. Biomaterials for reconstruction of the internal orbit. J Oral Maxillofac Surg. 2004;62:1280–97.PubMedCrossRefGoogle Scholar
  45. Reymond J, Kwiatkowski J, Wysocki J. Clinical anatomy of the superior orbital fissure and the orbital apex. J Craniomaxillofac Surg. 2008;36:346–53.PubMedCrossRefGoogle Scholar
  46. Rhee JS, Kilde J, Yoganadan N, Pintar F. Orbital blowout fractures: experimental evidence for the pure hydraulic theory. Arch Facial Plast Surg. 2002;4:98–101.PubMedCrossRefGoogle Scholar
  47. Schön R, Metzger MC, Zizelmannn C, Weyer N, Schmelzeisen R. Individually preformed titanium mesh implants for true-to-original repair of orbital fractures. Int J Oral Maxillofac Surg. 2006;35:990–5.PubMedCrossRefGoogle Scholar
  48. Tessier P. Inferior orbitotomy: a new approach to the orbital floor. Clin Plast Surg. 1982;9:569–75.PubMedGoogle Scholar
  49. Warwar RE, Bullock JD, Ballal DR, Ballal RD. Mechanisms of orbital floor fractures: a clinical, experimental, and theoretical study. Ophthal Plast Reconstr Surg. 2000;16:188–200.PubMedCrossRefGoogle Scholar
  50. Waterhouse N, Lyne J, Urdang M, Garey L. An investigation into the mechanism of orbital blowout fractures. Br J Plast Surg. 1999;52:607–12.PubMedCrossRefGoogle Scholar
  51. Wilson S, Ellis III E. Surgical approaches to the infraorbital rim and orbital floor: the case for the subtarsal approach. J Oral Maxillofac Surg. 2006;64:104–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Simon Holmes
    • 1
  • Michael Perry
    • 2
  • Joe McQuillan
    • 3
  • Steve White
    • 4
  1. 1.Craniofacial Trauma UnitBarts Health NHS TrustLondonUK
  2. 2.Regional North West London Craniomaxillofacial unitNorthwick Park and St Mary’s Major trauma service, Northwick Park HospitalHarrow, MiddlesexUK
  3. 3.Craniofacial Trauma UnitBarts Health NHS TrustLondonEngland, UK
  4. 4.Regional Eye UnitRoyal Victoria HospitalBelfastUK

Personalised recommendations