The late treatment of vertical orbital dystopia resulting from an orbital roof fracture.

Traumatic fracture of the orbital roof is uncommon and it may be unrecognized at the time of injury. In this article we describe a patient with progressive vertical orbital dystopia four years after he sustained a fracture of his "frontal" bone. Surgical exploration revealed an orbital roof fracture complicated by a chronic dural leak. An intracranial-extracranial approach through a modified frontal craniotomy provided excellent visualization to elevate the bony orbit and globe safely and repair the dural tear. Our study illustrates the need to correct residual soft tissue deformity at a second operation. Orbital roof fracture is a complex injury and is best treated by a multispecialty team using the methods learned from the treatment of patients with congenital orbital dystopia.