The orbits are located on both sides of the vertical midline in the center of the craniofacial region, occupying an extremely important position in the craniofacial skeleton and playing an important role in the formation of the craniofacial appearance. Orbital fractures can be caused by facial trauma, such as car accidents, punching injuries, throwing objects, and falling from a height. After orbital fracture, due to the enlargement of the orbital cavity, soft tissue edema, extraocular muscle edema, displacement or incarceration, resulting in a series of clinical manifestations, such as early protrusion of the eyeball, subcutaneous hematoma, subconjunctival hemorrhage, etc., and in late stage, there may be eyeball invagination, diplopia, infraorbital nerve palsy and other appearance deformities and functional disorders. Orbital fractures are categorized according to the cause of injury and the parts involved: orbital burst fracture and orbital compound fracture. They are categorized according to the length of time since the fracture: fresh fracture and old fracture. Not all orbital fractures require surgery, and the decision to operate depends on the patient’s specific condition. For small orbital fracture with no obvious eyeball inversion and diplopia, or for bilateral orbital fracture with no diplopia and symmetrical eyeball protrusion, which does not affect the appearance of the patient, surgery is not necessary. Surgery is required for large orbital fractures, obvious eyeball invagination (>2mm), diplopia that is not easy to recover, and extraocular muscle or soft tissue embedded, as well as obvious eyeball displacement. Surgery for orbital fracture is both therapeutic and cosmetic and reconstructive in nature, so the requirements for surgery are high. The surgeon should examine the patient in detail before surgery to know the preoperative visual acuity, eye movement, diplopia, infraorbital nerve injury, limitation of mouth opening, and the degree of eye invagination, and read the orbital CT films (including orbital CT scan, coronal scan, sagittal reconstruction, and three-dimensional reconstruction) carefully in person, to know the site of orbital fracture, the range of size, the distance of posterior edge of the orbital fracture from the optic canal, the presence of muscle embeddedness, rupture, and the existence of compound fracture of other parts. If the fracture is a compound orbital fracture, the patient should be operated with related departments, such as oral and maxillofacial surgery, otorhinolaryngology, etc. The patient’s appearance and the orbital CT scan should be analyzed. The patient’s appearance and orbital CT should be photographed and detailed information should be taken to facilitate postoperative comparison and observation of the surgical results, as well as to improve surgical skills by reviewing and analyzing the information at any time after surgery. Since orbital fracture surgery is a kind of plastic and cosmetic surgery, detailed surgical design should be carried out before surgery, such as the design of surgical incision, the material of intraorbital implant, and the selection and design of the size and shape of the implant. The design of surgical incision should be based on the principle that the smallest and most hidden incision should be used to maximize the exposure of the surgical field. The most commonly used incision is the natural skin fold incision, which can hide the scar in the natural fold. In addition, if the original skin wound scar is formed, if the original wound can be incised for surgery, such an incision should be used as much as possible to minimize scar formation. At present, the commonly used orbital fillers for repairing orbital wall fracture are Medpor, hydroxyapatite composite material, etc., and the shapes of bone plate type and molded wedge implant for eyeball collapse, etc. This kind of wedge implant for eyeball collapse has two specifications of sizes: (1) one kind of 31mm long×22mm wide×7mm thick; (2) the other kind of 40mm long×28mm wide×7,5mm thick; the bone plate type is thinner, and if you want to increase the volume to improve your eyeball, the bone plate type is more thin, and the bone plate type is more thin, and the bone plate type is more thin, and the bone plate type is more thin, and the bone plate type is more thin, and the bone plate type is more thin. If you want to increase the volume to improve the eyeball invagination, you can only increase the number of layers of bone sheet, which may increase the chance of postoperative intraorbital infection. The eyeball collapse wedge composite has an obvious advantage over the bone plate material in correcting the eyeball invagination, and its shape is similar to the contour of the orbital floor wall, which does not need to be trimmed or slightly trimmed during the operation, and it is suitable for repairing the fracture of the orbital floor and the lower wall of the orbit. I. Fractures of the inferior orbital wall Under-eyelash incision, lower fornix conjunctival incision, and transmaxillary sinus hydrosalpinx method can be used to repair orbital floor fracture, and the commonly used surgical incisions are the first 2 kinds. Repairing orbital floor fracture via sublash approach The skin is incised 2mm under the eyelash of the lower eyelid, and the skin is extended to the lateral canthus obliquely at an angle of 120° to the lower part of the canthus for about 10mm, and then separated from under the orbicularis orbicularis muscle to the infraorbital rim, and then incised the orbital rim periosteum, and then separated to the floor of the orbital rim from under the periosteum. During the operation, the infraorbital neurovascular bundle should be carefully recognized, and the infraorbital neurovascular bundle should not be regarded as the orbital content that is caught in the maxillary sinus, otherwise, it may result in postoperative numbness of the side of the affected person. 2.Transforaminal conjunctival incision for repair of infraorbital wall fracture This incision can be used for patients with infraorbital wall fracture of small extent or with inferior rectus atony, or patients with high requirements for appearance. This incision is hidden and leaves no obvious scar after surgery. However, this incision requires incision of the inferior branch of the lateral canthal ligament and freeing of the lateral aspect of the lower lid to enlarge the operative field and facilitate the exposure of the orbital floor. After surgery, the lower branch of the lateral canthal ligament should be carefully sutured to restore the shape of the lateral canthus, so as not to cause lateral canthus deformity. Second, orbital wall fracture X-ray cannot show the fracture of the orbital wall alone, so orbital CT axial scan + coronal scan should be done before surgery to know the length of the fracture of the orbital wall, the distance of the posterior edge of the fracture from the anterior end of the optic nerve canal, and the coronal scan to know the fracture of the lower and upper orbital wall, and the height of the sieve plate, so as to make sure that there is a good understanding of the situation during the surgery, and to prevent damage to the optic nerve and the cranial brain during the surgery. Surgical repair can be done through the transcutaneous approach or the conjunctival approach. In the transcutaneous approach, the incision is about 6mm from the medial canthus, and the skin and subcutaneous soft tissues are incised longitudinally to the periosteum. After the periosteum is incised, the lacrimal sac should be turned over to the outside, and separated along the subperiosteum, so that the orbital content which is detached from the sieve sinus is also incorporated into the orbit, and the anterior sieve artery should be cut off by electrocoagulation if it is normal, and attention should be paid to the depth of separation into the orbit and it should not be too deep to injure the optic nerve during operation. In the transconjunctival approach, the lateral canthus should be incised and the lower lid should be freed to enlarge the medial orbital field. Compared with the skin approach, the transconjunctival approach has a narrower field and is not suitable for those with a large range of fracture of the medial orbital wall, but there is no visible scar after the transconjunctival approach. Compound orbital fracture with inward and downward displacement of the eyeball The downward displacement of the eyeball is mostly seen in compound orbital fracture. The fracture of the anterior orbital region is accompanied by displacement of the orbital rim outward and downward, and a large amount of orbital content is herniated into the maxillary sinus, resulting in downward displacement of the eyeball. Surgery should be performed in conjunction with oral and maxillofacial surgery, and the incision should be extended under the lower eyelash to repair zygomatic arch fracture, and combined with an intraoral incision to repair maxillary, zygomatic arch, and nasal fracture, etc. After fixation of the fracture of the orbital rim to restore the anatomical position, the subperiosteal separation of the periosteum of the infraorbital wall is done to reset the orbital content that has herniated into the maxillary sinus, and the orbital implantation of the prosthetic material is performed to improve the incarceration of the eyeball, and the eyeball is lifted upward and elevated to the normal position. The eyeball will be elevated to the normal position. Old orbital wall and lower wall fracture Failure to correctly recognize the degree of orbital burst fracture, improper selection of indications for conservative treatment, delay in early surgery, resulting in ocular invagination, limitation of eye movement, diplopia, etc. Active treatment should be carried out to address the above conditions, and the order of treatment is to first correct the invagination of the eyeballs, and then carry out extra-ocular muscle surgery to improve the ocular movement disorders and diplopia. These patients generally have a more severe ocular invagination, and it is difficult to completely correct the obvious ocular invagination by simply implanting bone plate-type restorative materials, and if the number of layers of bone fragments placed is increased, the risk of postoperative intraorbital infection may increase. The application of wedge-shaped implant can correct the eyeball invagination within 4-5mm, and the thickest part of the implant should be placed as far back as possible or behind the equator of the eyeball during the operation, which is better to correct the effect, otherwise, it may cause upward displacement of the eyeball. V. Orbital fracture combined with eyeball injury 1. When the orbital fracture causes limited appearance, and at the same time the eye injury causes complete loss of visual function, and the vision can no longer be restored, we think it is necessary to perform orbital fracture surgery to improve the patient’s appearance. When the injured eye has normal intraocular pressure, no pigmented membrane reaction, and no signs of atrophy of the eyeball, orbital fracture repair can be performed purely to improve the inward appearance of the eyeball. 2.When the eye is more seriously injured, the intraocular pressure is low, there are signs of atrophy of the eyeball, or there is a pigment membrane reaction, the orbital wall fracture should be repaired at the same time as the removal of the eyeball and implantation of prosthetic tires. If the orbital wall fracture is not repaired at the same time, there is a risk of downward or medial displacement of the prosthetic tire and the development of a sunken eye socket. In order to avoid postoperative depression of the eye socket, the eye socket should be filled with implanted material until the height of the prosthetic eye tire is equal to the corneal apex of the healthy eye, and then it can be depressed by about 2mm after the postoperative swelling subsides, and the appearance of wearing the prosthetic eye piece at this time is more satisfactory. 3.When orbital fracture combined with ocular trauma, the eyeball damage is more serious need to perform vitrectomy, the choice of the timing of the operation is particularly important. We usually choose 10-14 days after the injury to perform orbital fracture repair surgery, at this time by the trauma caused by subcutaneous bruising, orbital soft tissue edema has basically subsided, the degree of eyeball subsidence can be determined, and at this time the orbital fracture area did not form a scar, the surgical damage is small, intraoperative bleeding is small, the effect is good. About 1 week after the fracture repair surgery, vitrectomy was performed again to remove the vitreous blood, reset the retina, etc., to improve the patient’s visual function. If orbital fracture repair surgery is performed after vitrectomy, there is a risk of retinal detachment, vitreous hemorrhage, and aggravation of lens dislocation caused by the compression of the eye during the fracture repair surgery.