[Reconstruction of the lower orbital wall in the remote posttraumatic period]

The authors share their experience gained in the treatment of 11 patients with different fractures of the lower orbital wall in remote periods after the injury (1 month to 4 years). A specific feature of late injury in all the patients we observed were disorders of binocular vision presenting as diplopia due to cicatricial changes in the orbit. X-Ray examinations showed deep fractures of the lower orbital wall involving the posterior half of the orbital space in all cases. An operation had to be performed in all the patients: inferior orbitotomy via a transcutaneous access combined with anterior highmorotomy and submucosal refracture of the upper wall of the maxillary sinus within the framework of improperly consolidated fracture along the borders of the orbital hernia. The choice of this operation was dictated by specific localization of the fractures (zones difficult to access), solidity of scar growth at the site of the fracture (because of long period elapsed after the injury), and by limited possibility of intervention via an isolated transorbital access. An accessory element: refracture of the lower deformed wall and its reposition in the proper state helped repair the defect in the wall with a homocartilage on the side of strips and the orbit. Binocular vision and mobility of the eyeball in the orbit were repaired in all the patients, the degree of posttraumatic enophtalmos was appreciably decreased.