Functional outcome after surgical treatment of orbital floor fractures (original) (raw)
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The Egyptian Journal of Plastic and Reconstructive Surgery, 2021
Aim: Orbital trauma is considered one of the most common maxillofacial traumas with functional and cosmetic impact to eye globe. The main objective is to establish a roadmap for the management of orbital floor fractures. Patients and Methods: One hundred and seventy-three patients were selected from the database of Mansoura University Hospitals with orbital floor fractures who were treated at the Department of Plastic & Reconstructive Surgery Department over past 4 years. Cases were retrospectively reviewed by preoperative clinical findings, management, surgical approaches, and sequelae. Authors evaluated timing and indication of surgical intervention, surgical outcomes, complications, and materials used for orbital reconstruction. Results: In total, there were (173) cases of orbital fractures with average age of (23.14) years. The leading cause of these fractures was motor traffic accident (64.7%). Pure blow-out fractures represent 25% of cases while fractures of inferior orbital rim alone were 45% of cases. Inferior orbital rim associated with orbital fractures were 30%. 57.2% of patients were managed surgically while 42.8% patients were managed conservatively. Conchal graft was used in 19 cases for floor reconstruction while 15 cases were managed by titanium mesh. In the follow-up, 10 patients still complain of enophthalmos, while 7 patients still complain of diplopia. Conclusions: Better postoperative results were presented in cases managed immediately or within two weeks surgically, A guideline for choice of effective protocol for management was developed.
Evolving Trends in the Management of Orbital Floor Fractures
Journal of Craniofacial Surgery, 2014
Background: The management of orbital floor fractures is diverse and continues to evolve. The purpose of the current study was to provide an updated summary of the literature, with a focus on interspecialty differences, and contrast that with current treatment strategies of actively practicing plastic surgeons. Methods: A survey was conducted of surgeons who currently manage orbital floor fractures. The results are summarized and compared with a 10-year literature review (2002Y2012) of surgical approaches, indications and timing of surgery, and implant selection in various surgical disciplines. Inclusion criteria included studies in English language with 10 or more patients. Results: The survey response rate was 56%, of which 86 surgeons were identified to currently manage orbit fractures. A third of participants reported they are less likely to operate on these fractures relative to earlier in their career. Six factors were found to have the greatest influence on surgeon's operative decision: enophthalmos, hypophthalmos, positive forced duction, defect size, motility restriction, and persistent diplopia. The most common preferred approach to the orbit is midlid/infraorbital (45%) followed by transconjunctival (31%) and subciliary (24%). Medpor and titanium are the most preferred implants (83%) compared with autologous bone (5%).
Retrospective survey of 150 surgically treated orbital floor fractures in a trauma referral centre
European Journal of Plastic Surgery, 2008
We present the epidemiology associated with 150 cases of orbital floor fractures surgically treated at a trauma centre. A 3-year analysis of patients surgically treated for orbital floor fractures at the University Hospital Virgen del Rocio, Sevilla, Spain, was conducted. Data regarding patient demography, signs and symptoms of presentation, cause and nature of injury, associated facial fractures, surgical approaches, materials used for orbital floor reconstruction and ocular damage were collected. Statistical analyses were conducted, including chi-squared and Fisher tests, odds ratios and confidence intervals. Men comprised 66.7% of the patients, and those aged 20-39 years were the most frequently affected. Male patients outnumbered female patients by a 2:1 ratio and were involved in a wider range of behavioural patterns resulting in orbital floor fractures. Motor vehicle accidents were the main cause, followed by physical assaults. The most common signs and symptoms associated with orbital floor fractures were periorbital ecchymosis and diplopia. Corneal abrasion was the most frequent positive ocular finding. This was followed in frequency by traumatic ocular globe rupture. However, most ocular injuries were of minor character. The ratio of impure to pure orbital floor fractures approached 3:1. We report results from one of the current largest series of surgically treated orbital floor fractures in a trauma referral centre. The most susceptible population included young men, and motor vehicle accident was the predominant mechanism. Further analysis of impure and pure orbital floor fractures revealed important differences in several demographic aspects such as mechanism of injury and signs and symptoms of presentation.
Turkish journal of trauma & emergency surgery, 2011
İzole orbita taban kırıklarının cerrahi endikasyonu, zamanlaması, kullanılacak rekonstrüksiyon materyali hakkında halen görüş birliği yoktur. GEREÇ VE YÖNTEM 2002-2010 yılları arasında izole orbita taban kırığı tanısı alarak ameliyat edilen hastalar (41 erkek, 13 kadın) geriye dönük olarak değerlendirildi. BULGULAR İzole orbita taban kırığı tanısı alan 54 hastadan, ameliyat edilen 49 hastanın cerrahi endikasyonuna bakıldığında, %20,4'ünde göz hareketlerinde kısıtlılık ve belirgin enoftalmi, %79,6'sında koronal planda çekilen bilgisayarlı tomografi görüntülerinin etkili olduğu görüldü. Hastaların %36,7'si ilk 16 saat içinde %10,2'si en geç 72-96 saat içinde ameliyat edildi. Orbita taban onarımı için ultra ince poröz polyetilen kullanıldı. Bu çalışma nedeniyle kendilerine ulaşılan 12 hastanın enoftalmi-egzoftalmi açısından normal sınırlarda olduğu, hiçbir hastada ektropiyon ya da skleral show bulgusu olmadığı, hastaların skara bağlı herhangi bir şikayetlerinin olmadığı görüldü. SONUÇ Tedavi edilmediğinde enoftalmi ve çift görme ile sonuçlanabilecek olan orbita taban kırığında, iyi prognoz doğru cerrahi endikasyon, erken cerrahi girişim ve uygun materyal ile onarıma bağlı olduğunu düşünmekteyiz. Anahtar Sözcükler: Bilgisayarlı tomografi; orbita kırıkları; orbita implantları; X-ışınları. BACKGROUND A common consent regarding repair indications, timing of repair and choice of reconstruction materials for isolated orbital base fractures does not yet exist. METHODS We retrospectively reviewed our patients (41 male, 13 female) who were operated due to a diagnosis of isolated orbital floor fracture between 2002 and 2010. RESULTS Fifty-four patients diagnosed with isolated orbital base fracture were found; 49 of 54 patients required surgery. The indications for surgery were restricted ocular motility and marked enophthalmos in 20.4% of the patients, whereas in 79.6%, surgical intervention was decided largely based on the coronal computed tomography images. 36.7% of the cases were operated earliest, in the first 16 hours, and 10.2% were operated the latest, in 72-96 hours. Ultra-thin porous polyethylene was used in the orbital base repair. Twelve patients contacted for this study were evaluated. Enophthalmia and exophthalmia were in normal limits in patients, and none of the patients displayed ectropion or scleral show findings or reported any complaints related to scar formation. CONCLUSION When not treated in a timely manner and with appropriate materials, orbital base fractures might result in enophthalmia and diplopia. We believe that a good prognosis of orbital base fractures relies on the right decision for surgical indication, early surgical intervention, and repair with appropriate material.
Long-Term Sequelae after Surgery for Orbital Floor Fractures
Otolaryngology–Head and Neck Surgery, 1999
A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary “supporting” antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of poro...
Repair of Orbital Floor Fractures: Our Experience and New Technical Findings
Craniomaxillofacial Trauma and Reconstruction, 2010
We report our experience with the repair of the orbital floor fractures and present new technical findings. We evaluated 30 subjects with pure blowout fractures treated at the Department of Maxillofacial Surgery of the Federico II University of Naples, Italy, between 2005 and 2007. A preoperative examination by computed tomography scans provided classification of the orbital floor fractures into small and large fractures by measurement of the bone defect to choose the appropriate reconstructive implant materials, resorbable or nonresorbable. The clinical follow-up has been performed at 1 week, 1 month, 3 months, and 6 months. We observed a resolution of preoperative symptoms. The scar was not evident, and there was an absence of postoperative complications. We concluded that the use of resorbable materials for small orbital floor fractures and nonresorbable materials for large orbital floor fractures offers satisfactory results in both functional and aesthetic considerations. Furthermore, the new technical findings allow standardization of the surgical technique to be more accurate, also reducing the economic costs.
Journal of Oral and Maxillofacial Surgery, 2020
This month's featured article is a systematic review and meta-analysis of orbital fracture repair timing and the resultant outcomes by Jazayeri et al. 1 A basic understanding of orbital trauma is helpful when reading the article. The following discussion begins with several summary points about orbital floor fractures, with commentary on the article afterward. Trauma to the orbit and surrounding region accounts for approximately one third of all facial fractures. 2 Orbital injury most commonly results from assault, followed by motor vehicle collisions, falls, and sports injuries. 3 Such injuries typically occur in younger males in their second to fourth decade of life. The most common site for an orbital fracture is the floor, accounting for approximately 50% of all orbital trauma cases. The second most common fracture site is the medial wall (25% of all orbital trauma). 4 In young children, orbital roof fractures are also relatively common. Orbital wall fractures can be seen in isolation or in conjunction with other fractures, such as nasoorbital-ethmoidal, zygomaticomaxillary complex, frontal, and Le Fort II/III fractures. Isolated orbital floor or medial wall fractures are referred to as blowout fractures. The putative mechanisms include hydraulic (trauma to the globe transmits pressure to the walls, causing a fracture) and buckling (trauma to the infraorbital rim is transmitted, causing the floor to buckle and fracture). Trap-door fractures occur when the fractured segment displaces and then reduces; this can trap the orbital contents, which can lead to restriction in extraocular movements, oculocardiac reflex, and soft tissue damage. The evaluation and management of orbital fractures is often challenging, especially because not all fractures will require surgical intervention. Both functional and esthetic considerations are crucial when determining whether and when to repair an orbital fracture. Evaluation Evaluation of the maxillofacial trauma patient begins with the Advanced Trauma Life Support algorithm, followed by a complete history and physical examination, including a full facial trauma evaluation. Key items related to orbital trauma include the following: History B Mechanism and timing of injury B Ocular history, including corrective lenses, previous surgery, pre-existing disease B Altered sensation (often present in the infraorbital nerve distribution) B Eye pain (at rest or with movement)
Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions
European Journal of Trauma and Emergency Surgery
Objective The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature. Study design One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications. Results The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The ave...