A Novel Dual-Catheter Drainage Technique for Prevention of Orbital Hematoma in Blowout Fracture Surgery

Abstract

Background:Retrobulbar hematoma after blowout fracture surgery is a devastating complication that can lead to permanent vision loss. When such complications occur, emergency interventions like lateral canthotomy are often required, resulting in additional tissue trauma. This study presents a novel dual-catheter drainage technique designed to prevent postoperative orbital hematoma formation.Methods:Eight consecutive patients who underwent orbital wall reconstruction between October 2024 and December 2024 were included in this study. The technique involves placing 2 modified 18-gauge angiocatheters: one positioned above the orbital plate toward the inferior orbital fissure, and another placed horizontally between the lower eyelid musculature and orbital bone. Four to 5 small holes were created around each catheter to enhance drainage efficiency.Results:Initial experience with a single catheter in 1 patient resulted in postoperative lower eyelid hematoma. After modification to a dual-catheter system, 7 subsequent cases demonstrated successful prevention of orbital hematoma formation. Significant drainage was observed during the first 48 hours postoperatively in all cases. No complications, such as infection, ectropion, or permanent diplopia, were observed. The catheter system was maintained for 2 to 3 days postoperatively, with consistent catheter occlusion noted by day 3 due to blood clot formation.Conclusions:This novel dual-catheter drainage technique demonstrates effectiveness in preventing postoperative orbital hematoma after blowout fracture surgery. The method's simplicity, minimal invasiveness, and strategic anatomic coverage make it a valuable approach for reducing postoperative complications and improving surgical outcomes. Further studies with larger patient cohorts are warranted to establish the technique's broader applicability.