Orbital floor fracture repair with placement of a porous polyethylene titanium implant
This is Richard Allen at the University of Iowa. This video demonstrates repair of a left orbital floor fracture with placement of a porous polyethylene implant embedded with titanium. Forced ductions are performed which are shown to be positive. A 4-0 silk suture is then placed through the lid margin to provide traction. A lateral canthotomy is performed with a 15 blade. A lateral cantholysis is performed with the monopolar cautery. A transconjunctival incision is then made with the monopolar cautery and dissection is carried out between the orbicularis muscle and the orbital septum. The edge of the conjunctiva is engaged with 4-0 silk suture. Dissection is continued to the inferior orbital rim. The periosteum is then incised with the monopolar cautery. The freer periosteal elevator is then used to elevate the periosteum from the orbital floor. The fracture is then encountered and the tissue is released from the fracture at all edges. Forced ductions are again checked which are now free. A Supramid implant is then placed to cover the fracture. In this case, it was determined that more support would be needed; therefore a porous polyethylene implant embedded with titanium was placed in a subperiosteal plane. The implant is then fixated to the inferior orbital rim with titanium screws. The transconjunctival incision is then closed with interrupted 7-0 Vicryl sutures. The cantholysis is repaired by suturing the inferior limb of the lateral canthal tendon to the superior limb of the lateral canthal tendon with a 4-0 Vicryl suture. The canthotomy incision can then be closed with a 7-0 Vicryl suture.