Delayed Reconstruction of Post-traumatic Enophthalmos and Orbitomaxillary Deformity 25 Years After a Childhood Dog-Bite Injury: A Case Report

Dog-bite injuries in children usually involve facial soft tissues, while associated craniofacial fractures are uncommon and may be overlooked during the acute phase.A 35-year-old woman presented with longstanding right periocular asymmetry, infraorbital hollowing, anterior maxillary depression, and a medial lower eyelid notch 25 years after a childhood dog-bite injury.Best-corrected visual acuity was 20/20 in both eyes, ocular motility was normal, and diplopia was absent.Hertel exophthalmometry measured 18 mm on the right and 22 mm on the left.Computed tomography demonstrated chronic deformity of the right inferior orbital wall and anterior maxilla.Through a transconjunctival lower orbital approach extended to the anterior maxillary wall, the deformed anterior maxilla was divided vertically into three segments, reconstructed with block allograft bone, and stabilized with titanium plates and screws.The orbital floor was reconstructed with contoured titanium mesh, and the lower eyelid notch was treated by wedge resection and primary repair.At one month, periocular symmetry and midfacial projection had improved; Hertel measurements were 22 mm bilaterally, and postoperative imaging confirmed the position of the orbital mesh and maxillary fixation.This case illustrates the need to evaluate orbital support, midfacial projection, and eyelid contour together when treating chronic combined orbitomaxillary deformity after childhood facial trauma.