Orbital Surgery

I had surgery 3 weeks ago for an orbital blow-out fracture.  The surgery was a year and a half after the injury, so an implant was put in to replicate the bone that now sits several inches below its original position and into the sinus cavity.  All was going well with the recovery and last week I felt fine and went skiing.  Coming down from the mountain and from elevation I started to feel the typical pressure in the ears and additional pressure in the sinus on the surgical side of the face.  By the time we were all the way down (~10,000 ft to sea level) the pain was fairly severe.  The next night I referee'd 3 games of hockey, which involves a lot of bending down to ice level to pick up the puck.

At this time i was feeling like I had sinusitus, as I had severe cases after the injury and before the surgery, with all the typical symptoms of pain in the upper teeth, pain in the sinus, but did not have the strong post nasal drip.  I went to my PCP believing that it was a sinus infection, and although the discharge in my throat was relatively clear, he prescribed 500 mg's of Ceftin just to be safe.

Two days later and with greatly increased swelling and a great amount of extra strength tylenol completely unable to control the pain, as well as pressure on the eye to the point that it was now about 2 cm too high, I went to see my surgeon, who sent me for CT Scans to find out more clearly what was going on in the sinus.  His concern was that air had gotten into the sinus and as causing the discomfort, and wanted to make sure it had not relocated the implant.  The CT scans showed a full sinus, although the scans done a year prior had shown a similar clogged sinus, but no air.  He prescribed a stronger antibiotic..875 mg of amoxicillian, while also believing there may have been some bleeding into the sinus causing the pain.

It the past few days since that appointment, I have noticed significant dark red mucus in clearing my throat that seems to me to be blood.  The pain generally comes about 2 hours after I wake up and lasts for about 2 hours where it's very strong then subsides as the day goes on.

My biggest concern is that as the swelling has gone down, I now feel something hard just below the eye, starting from around the tear duct on the nose side and running at a 30 degree angle down below my eye and away from the nose.  I'm concered that this may be the implant that has, since the CT scan, repositioned itself due to whatever factors that I can't explain.  I've felt this hardness for 4 days now without any perceivable change in location.  

Before I thought about the possibility of needing further surgery, I wanted to see if there was some explaination for the hardness that I feel below the eye.

Thanks

[John C Hagan III, MD, FACS, FAAO]

Use the search feature and archives. We have very long and enlightening discussions of the long time it takes after orbital surgery.

JCH MD