About Curtis J. Edwards, MD, FACS Expertise Can answer general and vascular surgery questions, trauma, burns, some plastic surgery questions, general gastrointestinal surgery and gastrointestinal medical questions and questions regarding aviation medicine.
Experience Board certified general surgeon. Seventeen years practice experience in general, vascular, and no-cardiac thoracic surgery and endoscopy.
Organizations College of Surgeons, AMA, Aerospace Medical Assoc., Civil Aviation Medical Assoc.
Education/Credentials BA, MD, American Board of Surgery, Fellow American College of Surgeons, seventeen years practice all phases, including teaching.
3 weeks ago I was in a bicycling accident resulting in multiple injuries (all superficial) one of which was a blowout fracture. I had surgery to repair the floor of the orbit (he inserted a thin plastic sheath to re-enforce it.) My questions are:
I had double vision right after the surgery which corrected itself after a few days (if I look straight ahead), but if I look down or to the right I still have double vision. Is this due to the swelling? (I still have a fair amount of swelling.)
Also, when I look at myself straight on in a mirror my right eye is positioned slightly higher and closer to my nose than my left eye. Did the surgery result in this or my initial impact when I fell off of my bike? Will this resolve when the swelling goes down or will I have to correct it? How is this corrected?
How long will it be until swelling is completely gone? It's been 3 weeks and although the swelling has gone down somewhat, there still is a fair amount of swelling.
Also, my upper lip and gums and a few teeth on the right hand side of my face are completely numb and have been that way since the accident. I've read that it could be nerve damage. Will that heal?
Answer My answer is provided for information purposes and does not constitute treatment or a diagnosis. You should seek out the care of a physician for treatment.
The orbit is supported by the nasal bones (nasal and lacrimal) medially, a thin bone that is the top of the maxillary bone (sinus) and laterally by the zygomatic bone as it connects to the temporal bone (cheek bone). This structure is also known as the tripod.
I am assuming you had a pure blow-out where the volume of the orbit was insufficient to accommodate the compressed globe and infraorbital muscle and fat. The fact that the inferior orbital wall is subject to fracture is a protective mechanism in preserving sight.
Your plastic surgeon used a silastic sheet to create a shelf or scaffold to reconstruct the floor and elevate the eye back into its anatomical position. Muscle entrapment can occasionally occur with these fractures and the most common is the inferior rectus, the muscle that makes the eye look down. The next most common muscle affected is the inferior oblique that allows the eye to look nasally and down. If either of the muscles have been entrapped or injured double vision can ensue. A normal part of the procedure is to tease the contents of the orbit up out of the sinus, aggressively seeking the borders of the fracture to its limits in the socket. Your surgeon undoubtedly did this and allowing time for swelling to resolve will almost certainly result in a correction of the double vision. If it doesn't resolve in another couple weeks then a mechanical problem with the surgery should be suspected, either an inadequate repair or a volume problem with the implant restricting the proper functioning of the muscles.
As to the numbness, this is in the distribution of the infraorbital and zygomatic nerves which can be traumatized in such a blowout. It is difficult to tell when or if a nerve will return to function. Nerves can be injured and die back to the edge of the injury. The axons will regrow at a millimeter per day. The distance may be as much as one hundred twenty millimeters.
I would have a frank discussion with your surgeon. Reimaging the area with thin slices and a three dimensional computed tomographic scan is probably indicated if the problem persists. It wouldn't hurt to also see a good ophthalmologist. Hope this helps.
