SURGICAL MANAGEMENT OF BLOW-OUT FRACTURES: PROTOCOLS AND RECONSTRUCTIVE TECHNIQUES

Abstract

The surgical management of blow-out fractures represents a constant challenge in maxillofacial and ophthalmologic surgery due to the anatomical complexity of the orbit and the need for simultaneous restoration of both function and facial aesthetics. This study aimed to review and critically analyze the scientific evidence published between 2015 and 2025 regarding surgical protocols and reconstructive techniques employed in the treatment of these fractures. It is an integrative narrative review of the literature, conducted in the PubMed, SciELO, and ScienceDirect databases, using combined descriptors in Portuguese and English related to “orbital floor fracture,” “blow-out fracture,” “reconstruction,” and “surgical management.” Fourteen articles meeting the eligibility criteria were included, encompassing clinical studies, reviews, and case reports. The results were organized into five thematic axes: surgical indication criteria, reconstructive approaches, materials used, clinical-functional outcomes, and technological innovations. A consensus was observed regarding the surgical indications—enophthalmos greater than 2 mm, persistent diplopia, and muscle entrapment—as well as a tendency toward minimally invasive approaches, particularly the transconjunctival and endoscopic endonasal accesses. Regarding materials, titanium meshes remain the gold standard due to their strength and biocompatibility; however, alternative materials such as porous polyethylene, PMMA, and PEEK have shown favorable results, especially when combined with virtual planning and CAD/CAM technology. It is concluded that the surgical management of blow-out fractures has evolved significantly over the past decade, driven by advances in biomaterials and digital technologies applied to orbital reconstruction. Nevertheless, there is still no consensus on universal protocols, highlighting the need for multicenter studies and systematic reviews to establish clinical guidelines based on robust scientific evidence.