Reconstruction of the orbital floor with a pericranial flap in a cocaine-addicted patient.

Background: The orbit is a complex anatomical region. Cocaine-induced midline destructive lesions (CIMDL) can severely damage the orbital walls. This study evaluates the effectiveness of the pericranial flap in reconstructing orbital defects in CIMDL patients, focusing on its proper positioning, stretching, and anchoring to the orbital bone.

Case description: We present the case of a 57-year-old male with a history of chronic cocaine use, who presented with enophthalmos, diplopia, and reduced vision in the left eye. Imaging revealed extensive destruction of orbital walls. After a prolonged period of cocaine abstinence, the patient underwent reconstructive surgery using a pericranial flap to restore orbital integrity. Postoperative imaging confirmed correct placement of the pericranial flap, which successfully restored orbital integrity and sealed the sinus communication. Clinically, the patient showed significant improvement in enophthalmos, resolution of diplopia, and enhanced vision.

Conclusion: Harvesting and positioning the pericranial flap under the eyeball, appropriately stretched and anchored to the orbital bone, are a feasible and effective technique for complex orbital reconstruction in CIMDL cases. This approach successfully restores anatomical structure, improves eye alignment, and resolves diplopia, supporting both anatomical restoration and functional recovery.