Late Repair of Orbital Floor Fracture, Is it Safe to Surgically Repair 6 Months Later?

Had orbital floor fracture in Aug 2011 with a soft tissue entrapment/ diplopia in extreme upper gaze and was not surgically repaired. Two months after the incident I started getting dizziness and felt that I was having ocular cardiac reflex which manifested in Bradycardia and my resting pulse dropped to 60 from 72. My blood pressure which was normal before the fracture now has elevated. My BP elevates abnormally high while walking. Irregular heart beat at night. How safe to get operated now.

Doctor Answers 5

Late orbital fracture repair

Surgery 6 months out is safe, but it may not correct your problem.  Early on, the muscle was being held by the disrupted bone.  At this point, it is being held by bone and scar tissue and the muscle itself may have developed scarring that won't change after surgery.  Surgery should be done only after repeat orbital imaging has been done and a complete exam by an orbital surgeon. 

Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Orbital floor fracture

I don't think there is any other option but further surgery. This type of surgery yields the best results when properly performed within a week or 2 of the injury. You say the August 2011 surgery failed to completely relieve the entrapment and the symptoms became worse around October 2011. That begs the question why have you waited till March/April 2012 to seek resolution the problem?

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Late Repair of Orbital Floor Fracture

You absolutely had an indication to have the orbital floor repaired immediately after the injury.  It is unlikely that the entrapment improved with a reduction in the swelling so you should still probably have the area treated.  You should get cleared by your primary care doctor for the surgery to evaluate the symptoms that you are having currently.  Due to the late repair and long term entrapment of the orbital contents you may still have problems with strabismus and enophthalmos following repair of the fracture and release of the orbital contents.

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Late Repair of Orbital Floor Fracture, Is it Safe to Surgically Repair 6 Months Later?

The main question is it indicated to repair the fracture now.  If it is, then there are more risks doing the procedure now then there would have been within 2 weeks of the surgery, but it still is a safe procedure in experienced hands.  You should see an Oculoplastic surgeon to see if it is indicated.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

This would actually be a reason to have surgery and what you are describing is possible.

I would recommend finding an oculoplastic surgeon to carefully assess your situation.  A late repair may or may not make a difference.  Imaging studies need to be done as well as a detailed assessment of your clinical situation.  It is ideal to reduce these fractures shortly after the injury.  As time passes, scars develop.  That does not mean that you can't have benefit from a repair, it is just that all these issues need to be weighed.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website that can assist you to find a well qualified surgeon (asoprs dot org).

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.