University of Iowa Health Care

Ophthalmology and Visual Sciences

Removal of superior orbital rim Bone Fragment

Richard C. Allen, MD, PhD

Additional Notes: Length 02:39

This is Richard Allen at the University of Iowa. This video demonstrates a patient with a displaced superior orbital rim fracture. The patient has a palpable portion of bone as well as hypo-globus. The area of the bone is palpated. A lid crease incision has been marked. The 15 blade is used to make an incision along the lid crease. The needle tip cautery is then used to dissect through the orbicularis muscle to the underlying orbital septum. Dissection is then carried out superiorly between the orbital septum and the orbicularis muscle to the superior orbital rim. Brow fat is appreciated and the displaced bone can be palpated. The periosteum is identified superiorly and the Freer periosteal elevator is used to dissect the periosteum from the underlying bone. The bone fragment is identified. The Freer periosteal elevator is used to dissect around it and a hemostat is then used to remove the fragment. Further dissection is carried out along the orbital roof. Hemostasis is attained with bone wax.  The orbital rim is then inspected. The rough edges are burred down with a drill. This will smooth out the contour of the superior orbital rim. Re-inspection shows the rim to have an appropriate contour.  The bone fragment is then inspected. It was determined in this case that reinsertion of the bone fragment would not be necessary. After hemostasis is obtained, the lid crease incision is closed with interrupted 6–0 Prolene sutures. The patient will return in 1 week for reevaluation

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last updated: 02/22/2017
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