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Background: Eye injuries are one of the most common sequelae of facial trauma. On the other hand extraocular muscle involvement entails the ocular motility disorders and double vision. The aim of this study was to assess the impact of orbital trauma on the social and professional activities of patients., Materials and Methods: The material consisted of 44 patients after orbital trauma. The objective assessment of the ocular apparatus, especially eye alignment and subjective complaints was performed. All patients were interviewed with a questionnaire in order to assess the impact of visual disorders on daily, and socio-professional activities., Results: The patients were mostly manual workers, living in urban areas, in whom assaults were the main cause of injury. Most of them showed good visual acuity, but 59% exhibited double vision. The ability to perform the former occupation was retained in 45.5% and 20.5% of workers could not perform the former job. Total or partial inability to work was certified in 23% of subjects. Orbital trauma also affected the functional vision of patients and decreased their quality of life; 30% of patients felt significant limitations in social function and 12% remained dependent on others for their daily activities., Conclusions: Orbital trauma and resulting double vision is an important factor influencing the professional activity. Double vision limits the ability to return to work, despite the lack of damage to the eyeballs and preserved good visual acuity. Orbital trauma causing diplopia does not significantly affect the social activities of the patients or their ability to drive.

Represented the way of orbital floor reconstruction using coronoid process of the mandible pedicled on temporal muscle. The clinical evaluation of vascularised bone graft from coronoid process confirmed their usefulness in the face recon struction surgery.

Unlabelled: Orbital fractures are one of the most frequent consequences following midfacial trauma. If not treated they can lead to serious optical complications as: double vision (diplopia), restriction of ocular motility, eyeball sinking (enophthalmos). Autogenic bone grafts although still wide and effectively used for reconstruction of the fractured orbital walls present some disadvantages. This is morbidity of the donor site, unforeseen resorption, time-consuming procedure and longer postoperative care. Because of that introduction of new materials for orbital reconstruction seems to be desirable. The aim of the work was to evaluate usefulness of the polydioxanone sheets (PDS) as a reconstructive material for orbital floor fractures., Material and Methods: From 1. 09. 2004 to 1. 02. 2006 111 patients with orbital fractures were treated in the Department of Maxillofacial Surgery Klinikum Minden. Age of the patients was between 15- 89 years (mean 43 y.); m:w ratio 78:33. There were 54 isolated orbital floor fractures (in 3 cases with additional medial wall fracture) and 57 zygomatico-orbito-maxillary fractures. The diagnosis was based on the clinical picture and coronal CT scans. The patients were operated through a transconjunctival (72%) or an infraorbital-Mustarde (28%) access and the orbital floor (medial orbital wall) was reconstructed with PDS sheet. Control examination was performed immediately, 1 moth and 6 months after the operative treatment., Results: There were 47% true "blow-out", 34% "trap-door" and 19% "en-clapet" fractures. The most important preoperative symptom was double vision (23%), restriction of ocular motility (18%), enophthalmos (3,6%), impairment of function of the infraorbital nerve (41%). Size of the defect was 3+/-1,13 cm(2) in "blow out" fracture, 1,8 +/-0,9 cm(2) in "trap-door" and 2+/-0,5 cm(2) in ,"en-clapet" ones. The primary reconstruction was successful in 97,3% of the cases. Any inflammation or reaction against implant was noted. Persistent double vision was present in 2,7%, restriction of ocular motility in 1,8% and enophthalmos in 0,9% after the primary procedure. These patients were submitted to reoperation. In 1 case badly positioned PDS sheet causing diplopia was removed. In another one, eyeball movement restriction was due to adhesions between the sheet and periorbital tissue. Visual status of this patient has improved after adhesiolysis. In 1 patient with a large bony destruction reconstruction only with PDS sheet was an inadequate treatment. In 7,2% of patients disturbances in the field of innervation of the infraorbital nerve were present 6 months after the surgery., Conclusions: Alloplastic, resorbable PDS sheets in most cases were a valuable material for the reconstruction of the orbital floor (medial orbital wall). Mechanical properties of PDS seem to be not sufficient for the reconstruction of extremely large bony defects. In these cases use of autogenic bone grafts or a titanium mesh should be rather considered.

In the last 20 years, 273 patients with blow-out fracture of the orbital floor were treated. Surgery was performed in 242 of them (88.6%). The typical features of this type of fracture as well as the methods and results of treatment are presented. Criteria of the recovery were disappearance of diplopia and decrease of enophthalmos.

On the basis of analysis of patients with posttraumatic diplopia pathomechanism, diagnostic procedure, methods of surgical treatment and its results were discussed. In the group of 1196 patients with injuries of the organ of vision posttraumatic diplopia was diagnosed in 536 (44.8%) patients, of which 331 (61.8%) underwent surgery. In this group recovery was obtained in 182 (55.0%) patients, while in remaining marked improvement was stated. Lack of knowledge in this field among specialists was pointed out and was confirmed by mistakes in diagnostics and methods of treatment. These factors markedly worsen final results of proper treatment.

The reported patient with contusion of the cerebellum complained also about diplopia on looking to the left and upwards. The latter complaint suggested the possibility of a blow-out fracture of the orbital floor with wedging-in of muscles. The patient had no signs of a direct orbital trauma, tomograms of the orbits demonstrated uneven floor of the left orbit. The test of passive movements of the eyeball confirmed this supposition. Surgical treatment was successful.