I’m sorry to hear about your congenital facial asymmetry. I understand from your history that you suffered an orbital blow-out fracture, and that you had it repaired.
Subsequently you are now experiencing headaches, and vertigo as a result of a shift in your eyeball and eye muscle position?
It is very difficult to comment on your specific case, as the causes for vertigo and shifting in your eyeball / eye muscle position are so variable, especially after significant trauma and subsequent repair (which appears to have been performed with a very thick bone graft as seen in your CT scan)!
Such causes may be due to the initial trauma, or surgery performed by your initial surgeon that subsequently affected your eye position or eye motility.
In particular you would need to do a Hess chart (to document eye movements in detail) that will help ascertain whether it is your eyeball position, movement or torsion that is causing your problem.
The treatment should be directed at the cause of your problem (i.e. in terms of eyeball position, area of restricted movement or induced torsion)
It may be difficult to comment on your specific condition, but it sounds exactly like a patient that I am managing right now!
This unfortunate patient sought me out for a second opinion after unsuccessful fracture repair in Penang, Malaysia with an autologous bone graft placed in the floor of the orbit (Similar to your situation, she had a high bone implant placed that was compressing the tissues between the eyeball and the bone-graft – this is also seen in your CT scan). She was deeply unhappy after surgery as she experienced very subtle eyeball movement restriction and torsional diplopia in all positions of gaze.
Hess chart examination for this patient however, did not reveal any abnormality at all.
Detailed examination of her post-fracture repair CT showed that she had significant reduction of her orbital space likely due to the height and position of the orbital floor implant likely causing compression and hence a lateral shift in the inferior orbital tissues!
I have arranged surgery for this particular patient in the coming months, and hopefully I will be able to restore her induced anatomical abnormality.
I’ll keep you informed of the outcome, but in the meantime, I would be delighted to assist with detailed evaluation and further advice as to how you should approach this problem which must be extremely distressing for you.
