Repeated Hemorrhage after Repair of Orbital Floor Fracture with a Silicone Implant

Hirohiko Kakizaki, Akihiro Ichinose, Yasuhiro Takahashi, Nobutada Katori, Alejandra A. Valenzuela, Masayoshi Iwaki

.

DOI: 10.4236/ss.2011.28090                

Abstract

A 16-year-old girl was accidentally kicked in her right eye by her cheerleading teammate in an exercise. Upward gaze ability of her right eye was severely impaired and computed tomography (CT) showed a trapdoor fracture of the right orbital floor. After surgical exploration, a silicone implant was inserted. No bleeding was confirmed at this time. The next day, CT detected a hematoma on the right orbital floor. The hematoma was drained and meticulous cautery was used to control any potential bleeding. The same silicone implant was re-inserted. Irrespective of attempts to avoid hemorrhage, this occurred twice after the respective evacuations. During a fourth operation, we removed the silicone implant simultaneously with hematoma evacuation. No hematoma has occurred since, and the patient’s ocular movement has dramatically improved to a normal binocular single vision field. When repeated hemorrhages occur after an orbital floor fracture repair with insertion of a silicone implant, removal of the implant is an effective strategy to resolve the hemorrhage.

Keywords

Trapdoor Fracture, Orbital Floor, Silicone Implant, Hematoma, Hemorrhage, Removal

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. A. Wilcsek, M. Kazim, I. C. Francis, S Sharma, J. B. Reed and D. E. E. Holck. “Acute Orbital Hemorrhage,” In: D. E. E. Holck and J. D. Hg, Eds., Evaluation and Treatment of Orbital Fractures-A Multidisciplinary Approach, Elsevier Saunders, Philadelphia, 2006, pp. 381- 389.
[2]	C. W. Browning, “Alloplast Materials in Orbital Repair,” American Journal of Ophthalmology, Vol. 63, No. 5, 1967, pp. 955-962.
[3]	S. Warrier, V. C. Prabhakaran, G. Davis and D. Selva, “Delayed Complications of Silicone Implants Used in Orbital Fracture Repairs,” Orbit, Vol. 27, No. 3, 2008, pp. 147-151. doi:10.1080/01676830802077611
[4]	J. A. Mauriello, J. C. Flanagan and R. G. Peyster, “An Unusual Late Complication of Orbital Floor Fracture Repair,” Ophthalmology, Vol. 91, No. 1, 1984, pp. 102-107.
[5]	J. S. Gilhotra, A. A. McNab, P. McKelvie and B. A. O’Donnell, “Late Orbital Haemorrhage around Alloplastic Orbital Floor Implants: A Case Series and Review,” Clinical Experimental Ophthalmology, Vol. 30, No. 5, 2002, pp. 352-355. doi:10.1046/j.1442-9071.2002.t01-1-00555.x
[6]	C. D. McCord Jr., “Orbital Decompression for Graves’ Disease: Exposure through Lateral Canthal and Inferior Fornix Incision,” Ophthalmology, Vol. 88, No. 6, 1981, pp. 533-541.
[7]	P. Cole, V. Boyd, S. Banerji and L. H. Hollier Jr., “Comprehensive Management of Orbital Fractures,” Plastic Reconstructive Surgery, Vol. 120, No. 7, Supplement 2, 2007, pp. 57S-63S. doi:10.1097/01.prs.0000260752.20481.b4
[8]	J. A. Mauriello Jr., S. Hargrave, S. Yee, R. Mostafavi and R. Kapila, “Infection after Insertion of Alloplastic Orbital Floor Implants,” American Journal of Ophthalmology, Vol. 117, No. 2, 1994, pp. 246-252.
[9]	D. R. Jordan, P. St Onge, R. L. Anderson, J. R. Patrinely and J. A. Nerad, “Complications Associated with Alloplastic Implants Used in Orbital Fracture Repair,” Ophthalmology, Vol. 99, No. 10, 1992, pp. 1600-1608.
[10]	S. J. Prowse, P. M. Hold, R. F. Gilmour, U. Pratap, E. Mah and F. W. Kimble, “Orbital Floor Reconstruction: A Case for Silicone. A 12 Year Experience,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 63, No. 7, 2010, pp. 1105-1109. doi:10.1016/j.bjps.2009.05.057
[11]	J. C. Mwanza, D. K. Ngoy and D. L. Kayembe, “Reconstruction of Orbital Floor Blow-out Fractures with Silicone Implant,” Bulletin Society Belge Ophtalmology, Vol. 280, 2001, pp. 57-61.
[12]	J. J. Xu, L. Teng, X. L. Jin, Y. Ji, J. J. Li and B. Zhang, “Porous Polyethylene Implants in Orbital Blow-out Fractures and Enophthalmos Reconstruction,” The Journal of Craniofacial Surgery, Vol. 20, No. 3, 2009, pp. 918-920. doi:10.1097/SCS.0b013e3181a2d728
[13]	P. A. Rubin, J. R. Bilyk and J. W. Shore, “Orbital Reconstruction Using Porous Polyethylene Sheets,” Ophthalmology, Vol. 101, No. 10, 1994, pp. 1697-1708.
[14]	G. P. Barnsley, L. J. Sigurdson and S. E. Barnsley. “Textured Surface Breast Implants in the Prevention of Capsular Contracture among Breast Augmentation Patients: A Meta-analysis of Randomized Controlled Trials,” Plastic Reconstructive Surgery, Vol. 117, No. 7, 2006, pp. 2182-2190. doi:10.1097/01.prs.0000218184.47372.d5