Staged multidisciplinary reconstruction of complex orbitopalpebral trauma with extensive eyelid avulsion following high-energy motorcycle injury: a care case report

Background: Complex orbitopalpebral trauma is an uncommon but devastating injury involving simultaneous disruption of the eyelids, lacrimal drainage system, orbital skeleton, and periocular soft tissues. These injuries threaten ocular integrity, visual function, eyelid mechanics, and facial aesthetics. Successful management requires rapid multidisciplinary assessment followed by staged reconstruction that prioritizes preservation of the globe while restoring eyelid function and facial anatomy. Case Presentation: A previously healthy 25-year-old man sustained severe left-sided facial trauma after a high-energy motorcycle collision. Clinical examination revealed extensive avulsion of the upper and lower eyelids, periocular soft tissue loss, facial lacerations involving the malar and nasal regions, and orbital trauma. Computed tomography demonstrated fractures of the orbital floor, lateral orbital wall, ethmoid complex, and anterior and posterior walls of the left maxillary sinus.The patient underwent emergency irrigation and debridement with removal of foreign bodies followed by layered soft tissue repair. Ophthalmologic surgery included conjunctival repair, temporary tarsorrhaphy, lower eyelid reconstruction, and attempted canalicular repair. Maxillofacial surgery performed open reduction and internal fixation of the facial fractures with titanium plates and orbital floor reconstruction. Residual upper eyelid tissue loss was subsequently reconstructed using a suprabrow advancement flap. Serial outpatient follow-up documented progressive wound healing, flap viability, stable ocular protection, gradual tarsorrhaphy release, and preservation of globe integrity. Conclusion: This case illustrates that staged multidisciplinary reconstruction combining emergency soft tissue management, skeletal stabilization, ophthalmologic reconstruction, and delayed local flap reconstruction can successfully restore eyelid coverage and ocular protection after devastating orbitopalpebral trauma. Careful coordination among specialties remains fundamental to optimize both functional and aesthetic outcomes.