This presentation reviews the principles of impure enophthalmos repair. Impure enophthalmos is defined as enophthalmos which is caused by disruption of the orbital rim. It can affect the supraorbital rim, nasoethmoid complex, or orbital zygomatic segment in any combination. This is very well demonstrated in this clinical case. Patient with an unrepaired left nasoethmoid and orbital zygomatic complex fractures resulting in profound left malar flattening, diminished width and altered inclination of the palpebral fissure, and significant enophthalmos and hypoglobus. How do we repair this? In this very same patient, we need to free all of the attached soft tissues, mobilize the orbital contents, osteotomize the displaced bone, and restore them to a normal position such that we have a normal orbital aperture. After this is accomplished, do we reconstruct the dimensions and shape of the orbital cavity. Interoperably in the same patient, you can see the soft tissues being stripped from the inferior orbital rim. Through the coronal approach, we dissect the temporalis muscle and periorbita to expose the zygoma. And as shown in this video, osteotomies are performed through the lateral orbital rim first and then through the zygomatic arch. At the zygomatic arch, I generally step the osteotomy so that I can gauge the direction and degree of zygomatic advancement. The osteotomy is then continued through the infraorbital rim and malar body. And finally, with retraction of the temporalis muscle and protection of the orbital contents, the reciprocating saw is introduced through the temporal approach such that the tip of the blade can be clearly visualized within the orbital cavity as the intraorbital osteotomy is conducted. Fine mineral dorti osteotomes complete the osteotomies. Remaining soft tissues will then be dissected free and the osteotomy segment will be completely removed. The osteotomy of the zygoma and an osteotomized nasoethemoid segment were repositioned to reconstruct the orbital aperture. You can see restoration of the normal position of the aperture as well as the projection and width of the zygoma. Finally, a custom orbital floor implant is applied to restore orbital volume, allowing us not only to restore symmetrical malar projection and symmetry to the pupal fissure, but also to correct both the enophthalmos and hypoglobus. Thank you.

enophthalmos

orbital rim repair

osteotomies

coronal approach

facial symmetry