Reconstruction of a Complicated Orbital Depression Fracture with Medial Wall and Globe Repositioning in a Horse: A Collaboration Across Disciplines and Specialties.
Authors: McMaster Mattie, Caldwell Fred, Gillen Alexandra, Hespel Adrien, Budny Patrick, Abarca Eva
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Orbital Fracture Reconstruction with Globe Repositioning in an Equine Athlete A 6-year-old Irish Sport Horse eventer with severe orbital trauma presented a complex surgical challenge: depression fractures of the facial bones combined with secondary globe displacement into the conchofrontal sinus, resulting from medial wall and floor collapse. The surgical team employed a multidisciplinary approach, utilising three-dimensional computed tomography modelling for presurgical planning, followed by staged reconstruction involving placement of a resorbable plate to the orbital floor and sinoscopic repositioning of the medial wall using tissue expanders for temporary stabilisation (removed after 3 weeks under standing sedation). The gelding achieved successful globe repositioning with maintained anatomical orientation, returned to ridden work within 3 months, and resumed competition at its previous level by 5 months postoperatively with no reported visual deficits. This case demonstrates that horses with severe orbital depression fractures resulting in abnormal globe position warrant consideration of medial wall and floor reconstruction rather than acceptance of permanent displacement, particularly in athletic animals where visual function and cosmetic outcome influence performance and welfare. The use of minimally invasive sinoscopic techniques combined with resorbable implants offers a practical framework for managing these challenging injuries in practice.
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Practical Takeaways
- •For severe orbital fractures with globe displacement, consider advanced surgical techniques including 3D imaging and sinoscopic approaches rather than accepting permanent globe malposition.
- •Tissue expanders can temporarily stabilize medial orbital wall reconstruction and be removed under standing sedation without general anesthesia, reducing overall recovery burden.
- •Successful orbital reconstruction may allow return to full athletic function—don't assume orbital trauma necessitates permanent retirement from competition.
Key Findings
- •Three-dimensional surgical planning enabled successful reconstruction of complicated orbital fracture with globe repositioning in a single horse.
- •Use of resorbable plates and tissue expanders placed via sinoscopic approach successfully restored normal globe anatomical orientation.
- •Horse returned to competitive work at previous level 5 months postoperatively with no reported visual deficits.