2. Etiology and population characteristics Rare; 5% of facial bone fractures Mostly 20-40y ~ 80%♂ ° High impact trauma (motor accidents) Isolated fractures are rare → 90% + other fractures o Frontal sinus o Orbital rims o NOE o Le fort

3. Physical signs and symptoms Paresthesia supraorbital and supratrochlear nerves. If displaced: o Enophthalmos/exophthalmos o Hyperglobus/hypoglobus o Diplopia Ocular discomfort Epiphora Limitation of eye movement Increased scleral show Symptoms = orbital floor # → CT Proptosis

4. Classification of orbital roof fractures Orbital roof fracture Nondisplaced Displaced Isolated Blow-in (roof ↓) Blow-up (roof ↑) + Supraorbital rim + Frontal sinus + Combination

5. Treatment modalities Non-displaced: generally requires no surgical intervention Blow-in (roof ↓): o hypoglobus and/or exophthalmos o requires surgical exploration, reduction and stabilization Blow-up (roof ↑): o Hyperglobus and/or enophthalmos or entrapment of the extra ocular musculature o observation and intracranial pressure monitoring o significant neurologic injury / functional impairment → exploration and repair

6. Uz-Leuven experience 2010- 2015: o 11 orbital roof fractures 5 nondisplaced with conservative treatment 3 displaced with conservative treatment 3 displaced with surgical intervention o Male/female ratio: 9♂ / 2♀

7. o Age: 20-40j = 3 (28%) 20j ˂ = 4 (36%) ˃ 40j = 4 (36%) o Etiology: High energy impact trauma: n = 6 Fall: n = 4 Fysical violence: n = 1 Uz-Leuven experience

8. Case 49y, ♂; High impact trauma Fracture of frontal sinus and left orbit met inward displacement Proptosis left eye and functional impairment

9. Case 3D rendering

10. Case Mirror of right to left side

11. Case Fabrication of 3D shell

12. Case Printed “3D Shell” Mirrored Orbit

13. Case Trans-palpebral approach Triangular polygalactic acid plate is used to support the orbital roof

14. Case Post-op

15. Case 2 1 month post-op o residual ptosis of left eye o minor hypesthesia left N. supra-orbit. o no funtional impairment/diplopia

16. Conclusions Orbital roof fractures → rare → serious morbidity Common etiology and population characteristics CT scan → Roof↔Floor Conservative treatment Surgical intervention → surrounding landmarks

17. Filip.debrauwer@gmail.com Thank you for your kind attention !