Mechanism and Emergency Management of Blast Eye/Orbital Injuries

Sabri T Shuker

Disclosures

Expert Rev Ophthalmol. 2008;3(2):229-246. 

In This Article

NOE Blast Injury & Immediate Management

Blast leads to complicated compressed middle third facial skeleton. These cases are more difficult to treat than in civilian (NOE) fractures, such as those due to direct blow or car accident injurys, which are frequently segmental bone fractures roughly on the bone line of weakness. Reposition by a direct or indirect approach, simple intraosseous wiring or mini plate fixation are enough for proper fixation. The crushed eggshell type of bone fragments requires restoration to the anatomic structure of the NOE to its natural and asthetic form with preservation of function. Accurate realignment and replacement of the components are by minimal reduced stability because there is no strong muscle traction or stress pullout. To have a fundamental appreciation of the orbital anatomy this can mostly be achieved by molding, mounting and stabilization by intranasal arc scaffold techniques. However, the author's experience on blast middle facial skeleton injury found that instead of focusing on rigid fixation, the basic tenets that provide the guidelines for the reconstruction in civilian type of injuries are not always practical in blast compressed injury. Coronal or local flap exploration to the blast-crushed NOE region with impaired blood supply and small fragmented bone mostly attached to its pereostium is not the best surgical choice.

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