Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis
Derek Sheen, MD¹; Cheryl Yu, MD²; Sarah Debs, MD²; Katherine M. Yu, MD²; Alyssa N. Calder, MD²; Kevin J. Quinn, MD³; Dimitrios Sismanis, MD⁴; Thomas Lee, MD, FACS^2
1University of Texas Southwestern Medical Center
²Virginia Commonwealth University Medical Center
³Mass Eye and Ear/Harvard Medical School
⁴Virginia Oculofacial Surgeons

Orbital floor fractures represent common sequelae of facial trauma that may result in significant functional and aesthetic consequences. This article presents a comprehensive overview of the management of a revision case involving an orbital floor fracture, focusing on complications related to extruded, infected orbital hardware. In addition, common mistakes that involve improper placement of orbital floor implant, poor implant sizing, and lack of adequate implant fixation are discussed.

The featured case involves delayed wound healing and a sino-orbital cutaneous fistula (SOCF) due to infected orbital hardware from a previous orbital floor fracture repair. The discussion centers on preoperative planning, including the choice of surgical approach (transconjunctival with lateral canthotomy) and implant material. Intraoperative neuronavigation was utilized as an adjunctive tool to confirm the position of the newly placed orbital implant. This case provides valuable insight on preventable complications for this procedure, nuances in surgical approach, and uncommon challenges faced by providers who perform operative facial trauma repair.