Indications & timing of orbital fracture repair: a dilemma

The orbit is a complex area as important and delicate anatomical structures are packed together into a small space. Orbital fractures may occur alone or in combination with other mid facial fractures including zygomaticomaxillary complex fractures, lefort II & III fractures, naso-orbital ethmoidal fractures or frontal bone/ orbital roof fracture. Various treatment modalities have been advocated for the orbital reconstruction post trauma, but indication and timing of orbital reconstruction is an important determining factor with respect to the incidence of potential post-operative complications. It is necessary to distinguish between immediate, early and delayed orbital reconstruction. It has been proposed that early surgical intervention i.e. within 2 weeks may improve the ultimate outcome. Diplopia with CT evidence of an entrapped muscle or periorbital tissue associated with non-resolving occulocardiac reflex, early enophthalmos needs immediate intervention. But on the other hand any surgical correction of enophthalmos should be decided after the tissue edema subsides in order to yield a favorable aesthetic outcome, this henceforth shows that it is not necessary to repair all orbital fractures immediately. In the current literature there is no uniformly accepted guidelines for treatment of orbital fractures with respect to the interval time between trauma and reconstruction. The management of orbital fractures still continues to be intriguing. The timing or the need for surgery is solely decided by the surgeon and is determined by his/her skills and experience. The aim of this paper is to throw light on the various treatment modalities including the chronology, need for surgery and the pre and post-operative complications.