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An Introduction to the Orbital Buttresses.

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  • 1From the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center.

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Summary

Researchers identified five buttresses within the internal orbit, crucial for facial structure. Understanding these orbital buttresses aids surgical repair and reconstruction of facial fractures.

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Area of Science:

  • Anatomy
  • Orthopedic Surgery
  • Radiology

Background:

  • Facial buttresses provide skeletal support and protection.
  • Damage to facial buttresses necessitates surgical repair.
  • The existence and characteristics of internal orbital buttresses were previously undescribed.

Purpose of the Study:

  • To identify and describe the buttresses of the internal orbit.
  • To analyze the frequency of orbital buttress fractures in patients with orbital trauma.

Main Methods:

  • Microcomputed tomography imaging of 10 human cadaver skulls.
  • Image processing, thickness, and heat mapping using Avizo and ImageJ software.
  • Review of computed tomography scans from 593 patients with orbital fractures.

Main Results:

  • Five internal orbital buttresses were identified: superomedial fronto-ethmoidal strut with deep orbital buttress, inferomedial strut with posterior ledge, inferior orbital fissure, sphenoid-frontal superolateral strut, and sphenoid lip.
  • The mean orbital buttress thickness was 1.36 mm.
  • Orbital buttresses were fractured in 35% of analyzed orbits; the inferomedial strut with posterior ledge was most commonly fractured (14.4%).

Conclusions:

  • This study provides the first description of internal orbital buttresses.
  • Orbital buttress anatomy is vital for reconstructive surgery, including fracture repair and oncologic procedures.
  • Knowledge of orbital buttresses is essential for surgical planning, implant placement, and restoring orbital function and aesthetics.