Complex orbital trauma: the role of rigid fixation and primary bone grafting

High-velocity trauma to the orbit is characterized by complete disruption of the orbital rim and comminution of the walls of the orbital cavity. The incidence of associated injury to the intraorbital contents, and to contiguous facial skeletal structures, is significant. Failure to recognize and repair the skeletal injuries results in progressive contracture of the overlying soft tissues, collapse of the bony framework of the orbit, and atrophy of incarcerated intraorbital contents. Immediate orbital reconstruction aims to restore and maintain the normal anatomy of the craniofacial skeleton. The introduction of computed tomography (CT) and craniofacial surgical techniques facilitates comprehensive evaluation of orbital fractures. Further adaptation of the principles and techniques of rigid internal skeletal fixation and primary bone grafting permits a stable, three-dimensional, anatomic reconstruction of virtually any traumatic orbital deformity.