By Robert C. Kersten, MD
    Subspecialty Day 2012: Oculofacial Plastic Surgery

    In this presentation from the 2012 Annual Meeting, Dr. Robert Kersten discusses his personal paradigm for fracture management has changed in the 10 years since Bernstine. Trapdoor fractures and marked limitation of vertical excursions are operated on urgently to reduce morbidity and unsatisfactory outcomes, but the majority of patients are counseled a prolonged observation period. Even in patients with large fractures, late enophthalmos is rare and can be repaired on a delayed basis. In patients with diplopia who do not show frank muscle entrapment, diplopia will likely resolve without surgery, and surgery is no guarantee that it will resolve. Delayed repair in these settings has results and outcomes comparable to those in which surgery is done within 2 weeks.