Definition
By orbit floor fractures we mean fractures of the orbital walls, where traumatic incarceration of soft tissue and/ or the infra- and supra-orbital nerve can occur. Orbit fractures can occur isolated (blow-out-fractures) or in combination with midfacial fractures.
During surgery the misplaced bone is lifted and put back in its original position.
 
Therapy Goals
The most important goal is to restore the eye function, motility as well as vision. An enophthalmus should be avoided or corrected, respectively. Other main focuses are the restoration of the nerve function, the conservation or reconstruction of the paranasal sinuses as well as the restoration of the orbital form. The lacrimonasal duct should be treated with care or repaired, respectively.
 
Treatment Indications
Clinical and/ or radiological evidence of a fracture
Ocular motility disturbance
Enophthalmus (>2 mm)
Herniation volume (> 1.2 cm3)
Palpebra emphysema
Sensory disturbance of the infra-orbital and/ or supra-orbital nerve
Double images
Visual restriction
Examinations
Inspection
Palpation
Aesthesiometry (infra- and supra-orbital nerve)
X-ray on 2 levels
Eye function examination
Computer tomography
Measurement of fracture size and transposed soft tissue
Magnetic resonance tomography
If indicated, ophtalmological examination

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Therapy
Conservative Therapy
Surveillance in slightly dislocated fractures without eye motility restriction and without restriction of the infra-orbital nerve.
 
Surgical Therapy
Orbit reconstruction
Fragment stabilization (osteosynthesis)
Decompression of the infra-orbital nerve
Reconstruction of the lacrimonasal duct
Removal of a functional impairment of the eye
Repositioning of prolapsed soft tissue
Reconstruction of the orbital floor, if indicated with implantation of alloplastic material
 
Additional Measures
Analgesic therapy
If indicated, antibiotic therapy
Decongesting measures
Ordering the patient not to blow his/ her nose
 
Recommendation
As a rule, the treatment is performed in hospital with special emphasis on the tight control of the eye function.

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