Orbital floor fractures are among the most common midfacial injuries—and understanding when and how to operate is key for every resident. In this episode, we break down the anatomy, evaluation, and evidence-based management of orbital blowout fractures, based on Gart & Gosain’s Plastic and Reconstructive Surgery 2014 review.

We cover:

• Mechanisms — buckling vs. hydraulic theory, and why both matter.

• Clinical findings — diplopia, enophthalmos, oculocardiac reflex.

• Timing of repair — urgent (<48 hrs) indications vs. delayed (within 2 weeks).

• Surgical approaches — transconjunctival vs. subtarsal vs. subciliary.

• Implant materials — bone grafts, porous polyethylene, titanium mesh, and resorbables.

• Pediatric nuances — trapdoor fractures, oculocardiac reflex, and growth considerations.

🔑 Key Takeaways:

1. Early repair (<48 hrs) improves outcomes in entrapment and oculocardiac reflex.

2. Enophthalmos >2 mm or >50% floor involvement = strong indication for repair.

3. Transconjunctival approach offers lowest visible scarring; avoid subciliary ectropion.

4. In children, consider resorbable materials to avoid growth restriction.

📚 Reference:
Gart MS, Gosain AK. Orbital Floor Fractures. Plast Reconstr Surg. 2014;134(6):1345–1355. DOI: 10.1097/PRS.0000000000000719

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