Computed tomography long‐term follow‐up of a facial fracture involving the orbit and paranasal sinus

BACKGROUND: Fractures of the facial bones involving the orbit are challenging conditions that require surgical treatment. OBJECTIVES: To describe preoperative and postoperative clinical and computed tomographic findings of an orbital rim fracture repaired using a reconstruction plate. STUDY DESIGN: Case report. METHODS: A 14-year-old Haflinger mare was presented with an open, depressed and comminuted fracture involving the frontal, nasal, lacrimal and maxillary bone, sinus system and the medial aspect of the orbital rim and wall on the right side, as diagnosed by CT. Fracture repair included orbital rim reconstruction with a pre-shaped 12-hole 3.5-mm LCP-reconstruction-plate and repositioning/fixation of several fragments, including one large frontal nasal bone fragment, with cerclage wire sutures. Despite an implant infection postoperatively, the fracture healing assessed by CT 10 weeks later was considered good, and the reconstruction plate was removed at the same time. RESULTS: CT follow-up 1 year after fracture fixation revealed excellent restoration and healing of the orbital rim and wall. Complete resorption of the large repositioned frontal/nasal bone fragment was observed, resulting in a skin-covered bone defect adjacent to the right sinus system. CT imaging also suggested a potential mucocele formation within the right sinus system. Both findings were clinically inapparent and identified solely on CT examination. CONCLUSIONS: An excellent long-term outcome was achieved in this orbital fracture repaired with application of a pre-shaped 3.5-mm LCP-reconstruction plate, despite sinus communication, severe comminution and later implant infection, as assessed by CT. In conclusion, CT proved highly valuable for a systematic approach to fracture treatment and perioperative assessment of facial fractures in the present case. Several findings that had not been previously described could be characterised for the first time based on CT assessment. However, the long-term clinical relevance of the described findings needs further evaluation.