Obstetric Analysis Essay

A 54 year old man sustained a left orbital fracture after a human assault. Immediately after the injury, the patient noticed diplopia and discomfort in all fields of gaze. At the initial examination, there was important periorbital edema, ecchymosis, marked limitation of infra duction and supraduction of the right eye and associated pain and diplopia in all fields of gaze, complete anesthesia in the left V2 nerve territory. In addition, there was 2.5 mm of right enophtalmos measured with Hertel exophtal- mometer.
A preoperative computed tomography (Fig- ure 2) scan showed an extensive fracture of the right orbital floor with major herniation of the orbital soft tissue in the maxillary sinus, of pure type. The clinical and radiographic findings supported the diagnosis of entrapment of the inferior rectus muscle.
After subperiosteal dissection to ex- pose the orbital floor, the herniated tissue was repositioned within the orbit and a 25 mm x 16 mm x 0.85 mm titanium floor plate was positioned over the bony defect (Figure 3). An in- traoperative forced duction test was performed to ensure the release of the incarcerated inferior rectus muscle. The periosteum was meticulously sutured at the orbital rim.
Postoperatively, the patient received intra- venous antibiotics (Cefuroxime 1g IV every 12h for 5 days), systemic corticosteroids (Dexamethasone 4mg/ml per day for 5 days). The patient still had diplopia during the first week of follow-up, perhaps owing to the initial muscle and soft tissue edema, thereafter, the ductions of the right eye normalized, and the diplopia resolved by the end of the first month of follow