in the real world...

[rubensan]

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who fixes orbital floor fractures? ophthalmology (oculoplastics)? ENT? regular plastics? does it matter?

 

[JR]

The short answer is: insurance and availability dictates who fixes fxs. ENT, oculoplastics, and facial plastics can do it.

We have one oculoplastics specialist who says he will do anything down to the mandible 😎 .

 

[drgregory]

we have an oculoplastics guy in the metro who does them. his surgical skills and outcomes are remarkable. our surgeons do simple blephs, but anything beyond goes to this guy - a true guru. he does le forte, floor, you name it.

 

[Photon Catchers]

I was once told that Ophtho fixes the floor and lateral wall fractures, ENT fixes medial wall, and Neurosurg fixes the orbital roof fractures. In reality, I agree with JR, that many specialties are capable of this. Let me also add that OMFS (Oral-Maxillofacial Surgery) can fix the fractures as well. OMFS surgeons are unbelievable (they fix all types of fractures, and in the real world often do their own anesthesia during their surgeries and perform their own nasal intubations for their cases, etc).

At our institute, they rotate who is on facial trauma call for the night: ENT, General Plastics, and OMFS. We (ophtho) get called in if there is a retrobulbar hem, proptosis, EOM restriction, lacrimal system lacerations, intraconal heme, ruptured globe, etc. Since we have one oculoplastics fellow who is on call q1, it would be hard for him to do fracture repairs every night.

JR - one of our oculoplastics attendings is the same way - he knows no limits! He does full face lifts, neck lipo, endobrow, you name it. We joke that his inferior boundary is the belly button