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Osteomyelitis of the Orbit – Case Report
Doumit G, Yaremchuk M
Cleveland Clinic
2012-01-29
Presenter: Doumit G
Affidavit:
The material proposed for presentation has not been published in any scientific journal or previously presented at a major meeting.
100% of the original work represents my work when I was a resident
Director Name: M Yaremchuk
Author Category: Attending
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This presentation with inform colleagues on new use of a well known flap to improve the care of patients with surgical complications
How will your presentation be used by practicing physicians in the audience?
Clinical
We report, for the first time, the use of radical debridement and forehead flap reconstruction for treatment of post traumatic osteomyelitis of the orbit with secondary lower lid cicatricial ectropion.
A 27-year-old female presented to our institution with a chronic left orbital infection with a draining sinus and cicatricial ectropion.
She had suffered multi-systems trauma including complex facial fractures in a motor vehicle accident 7 years earlier. She had undergone extensive facial reconstruction for bilateral Lefort III fractures, including cranial bone graft reconstruction of her left orbital floor and rim. Within weeks, she developed drainage from the left orbit. Multiple operations including removal and replacement of infected bone graft, local debridement, local flap coverage, and endoscopic maxillary antrostomy with removal of granulation tissue had been performed. She had also been treated with multiple long courses of intravenous antibiotic therapy.
A three stage surgical reconstruction was performed including: 1-orbitotomy, debridement of left orbit floor with removal of titanium mesh and devitalized cranial bone graft; 2- left paramedian forehead flap with concha cartilage graft to obliterate dead space and reconstruct the lower lid; 3- division and inset of the forehead flap.
She received 6 weeks of intravenous antibiotic therapy addressing bacillus and enterobacter grown from intraoperative specimens.
The patient is currently 2 years since her last procedure with no sign of infection recurrence.
Radical debridement of devitalized tissue, removal of foreign bodies, and obliteration of dead space with well vascularized soft tissue can be effective treatment for chronic orbital infection.
