2 Months Post-op Orbit Reconstruction?

I had surgical repair of the orbit last June 2013 due to a blowout fracture in the posterior floor. The reconstruction of the inferior orbital wall was carried out using septal cartilage, but the extent of repair was limited by the proximity of the fracture to the inferior rectus muscle. After two months I still have some tense swelling and experience bruising under the eye in the evening or when I perform daily activities like washing. Is this normal please ?

Doctor Answers 1

Cartilage for repairing orbital fractures is described in the literature.

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Having said that, it is not a first line material for this purpose.  The vast majority of orbital blowout fractures are repaired with medpore sheets, titanium sheets, or titanium reinforced medpore sheet.  Not all blowout fracture need to be repaired.  The ones that do, typically involve a combination of the orbital floor and medial wall of the orbit.  The floor fracture may extend far posterior to reach the palatine bone.  There are very few orbit fractures that resemble the pictures in the old plastic surgery texts that appear as a small round piece of bone knocked out by the force of the fracture that only needs a small covering to prevent the orbital contents from prolapsing back into the hole.  One can image that , for such fracture,  a generous piece of septal cartilage might be ideal.  Perhaps you had such a fracture.  The story about the inferior rectus does not really make sense.  Two months out, my pro sports athletes return to competition generally without an issue.  Clearly something is going on.  I recommend seeing a University based oculoplastic surgeon to be assessed to determine what is going on with the orbit.  I would advise you to return to your plastic surgeon but the use of the septal cartilage raises a question in my mind and I think an independent opinion would be of great value.  In Georgia, your options are a bit limited.  I would recommend Ted Wojno, M.D. at Emory in Altanta. A state over in North Carolina, Jonathan Dutton, M.D.  There are others of course but you are obviously having an issue and will benefit from seeing surgeons who really do this type of work for a living.

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