Late treatment of orbital fractures: a new analysis for surgical planning

Surgical treatment of orbital fractures should be performed without delay; in some cases acute management is not possible due to general conditions and might be delayed for weeks or months. In the latter case, the fractured fragments can consolidate improperly, causing secondary deformities of the orbital region with aesthetic and functional alteration. Surgical planning of secondary deformities is critical for adequate pre-operative planning. In the last decade an increasing number of dedicated software applications for surgical planning have been developed. Standard computed tomography (CT) or the relatively new cone beam CT can be used for diagnostic purposes, pre-surgical visual treatment outcome and virtual surgery. In this report, the authors propose their pre-operative planning analysis for surgical correction of secondary deformities of orbital fractures. The treatment of orbital fracture must, in fact, analyse not only the bone structures but the soft tissue and surrounding periorbital region. The position of the orbit in the space should be determined in relation to the surrounding structures compared to the contralateral side, if this is not affected by the trauma or pre-existing malformations.