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SERVICES: Facial Fractures

What is a blow-out fracture?  


A blow-out fracture is a specific type of injury to a bony wall of the eye socket (orbit).  The eye socket has four walls.  Some of these are nearly egg-shell thin and are susceptible to breaking during an accident, particularly if the cheek or the eye are hit with a heavy blow.  A powerful blow to the eye can force the eye backward into the eye socket, compressing the tissue within the socket under high pressure.  This pressure can break the thin walls of the eye socket; the floor of the eye socket is one of the weakest walls and is commonly broken.  Occasionally, the broken wall is the wall of the socket next to the nose.  Other walls of the eye socket can break too, but injuries that break those walls are usually something other than sudden, high pressure in the eye socket.  


What symptoms are common in a blow-out fracture?


Blurry vision is a very common symptom after a major facial injury, and it can have many causes.  The eye itself is sometimes injured by the same blow that causes the blow-out fracture.  Blurry vision can also result from swelling of the eyelids and mucous membranes around the eye.  This can lead to tears pooling on the eye, distorting a patient’s vision.  Some patient’s will also experience double vision, which like blurry vision, has a number of causes.  Sometimes the muscles around the eye are bruised, preventing these muscles from aligning both eyes properly.  Other times, the muscles can get trapped by the rough edges of the broken bones in the eye socket.  It is important to have a careful eye exam to look for the causes of blurry vision or double vision, because without a good exam, it is impossible to know the cause of a patient’s symptoms.  Timely, appropriate care is critical for the eye and vision.  


Will I need any testing?


Most patients will get a special X-Ray test, called a CT scan or “CAT scan.”  This test gives Dr. Repp a clear picture of where the injury is and how severe it is.  Equally important is a carefully eye exam to look for any injuries to the eye. 


How is a repair for a blow-out fracture done? 


A blow-out fracture forms a hole in one of the walls of the eye socket.  Most techniques to repair these fractures attempt to cover this hole with a substitute material, similar to placing a manhole cover over a hole in the street.  Generally, these substitute materials are left in the socket forever, although occasionally they are removed.  Many materials can be used, but typically, they are a thin sheet of material to cover the hole in the wall of the eye socket.  

The incision for surgery can often made on the back of the lower eyelid, although other locations are possible.  Through this small incision, Dr. Repp can access the injured wall of the eye socket and place an implant of material over the broken area of the socket.  


Do all blow-out fractures need to be repaired?


No.  In fact, many patients heal well on their own without surgery.  It’s important to talk with Dr. Repp to get a better idea on whether your fracture requires surgery.  


What should I expect the day of surgery?


An orbital blow-out fracture repair is typically an outpatient procedure, allowing you to recover at home following surgery.  


Surgery is commonly done in an ambulatory surgery center, although sometimes the surgery is done in a hospital.  Repair of a blow-out fracture is often done with you fully asleep under general anesthesia, although there are exceptions.  During surgery, an anesthesiologist will monitor you to keep you comfortable.  Once your comfort is assured, Dr. Repp will repair the fracture.  


After surgery, most patients will return home the same day for their recovery.   


What about recovery and aftercare?


Each patient is unique, so Dr. Repp will customize an after-care plan for you, but some general guidelines follow.  Ask Dr. Repp if these apply to you before following any of the recommendations on this site.  And if something does not seem right, do not hesitate to call Dr. Repp.


Most patients will use frequent cool compresses for the first two days after surgery.  During this time, Dr. Repp will likely ask you to limit activity, commonly recommending that you avoid any heavy lifting or bending.  These activities can stress your surgery site and set back your healing.  Similarly, it important to avoid nose blowing for two weeks, because the eye socket shares walls with the sinuses around the nose. Following surgery, most patients experience only mild-to-moderate discomfort that can often be effectively treated at home with medications recommended by Dr. Repp.  If you experience more than mild pain or discomfort, you should call Dr. Repp immediately for recommendations.  You will also need regular ointment to the eye and any incisions.  The ointment acts as a salve, soothing the incision as it heals.  


Many patients wonder when they can safely return to work or other normal activities.  There is no single answer for every patient, so ask Dr. Repp for details.  Lastly, Dr. Repp may place sutures during your surgery.  If you do have sutures, typically, these are removed between one-to-two weeks following surgery.  Ask Dr. Repp for details.  

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