Abstract
This study is aimed to determine the relationship between orbital fracture sites in each CT scan view and postoperative diplopia. Data for 141 patients of orbital wall fracture were analyzed retrospectively. One group of examiners reviewed sagittal, coronal and axial CT scans. Descriptive statistical analysis was used to assess each fracture area and its potential relationship with the occurrence of postoperative diplopia. Among the three anatomical views, sagittal sections were significantly associated with post-operative diplopia (PD) (p = 0.044). For orbital wall fractures in a single location, C1 (p = 0.015), A1 (p = 0.004) and S3 (p = 0.006) fractures were significantly related to PD. Orbital wall fractures found in more than one location resulted in a higher probability of PD in all sections:, C1 + C2 group (p = 0.010), C1 + C2 + C3 group (p = 0.005), A1 + A2 group (p = 0.034), A3 + A1 group (p = 0.005), S1 + S2 group (p < 0.001), S2 + S3 group (p = 0.006) and S1 + S2 + S3 group (p < 0.001). For combinations of two or three sections, we found that only fractures involving both coronal and sagittal sections led to a significantly increased risk of PD (p = 0.031). PD is the main posttreatment complication of orbital bone fracture reduction. In addition to the known myogenic cause (failure to relieve entrapment) of diplopia, both trauma and surgical manipulation can compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. Careful assessment of patient symptoms (whether preoperative diplopia is present), and the location of orbital fractures (and the influence of related musculature, fat, and nerves) on CT scans are strongly related to surgical success.
Highlights
When orbital trauma is suspected, an immediate and appropriate diagnosis is crucial to allow early treatment
Regarding the laterality of injured eyes, the right eye was affected in 8 patients (20 in the left eye) in group 1, while the right eye was affected in 17 patients (96 in the left eye) in group 2
In addition to orbital wall fracture, associated injuries were common in these patients; traumatic optic neuropathy was the most common in group 1 (2, 7.1%), and facial trauma was the most common in group 2 (21, 18.9%). (Table 1) There were 98 patients with pre-operative diplopia and 28 patients with post-operative diplopia (PD)
Summary
When orbital trauma is suspected, an immediate and appropriate diagnosis is crucial to allow early treatment. Computed tomography (CT) is the most common method used for imaging diagnosis in orbital traumatology It provides information regarding the location and size of orbital fractures and possible associated soft tissue damage. Orbital CT provides information regarding whether “emergency surgery” is required The combination of both clinical investigation and imaging allows correct diagnosis and successful treatment of these fractures. We analyzed the probability of postoperative diplopia in each section of orbital wall fractures. The results of this analysis can remind physicians to pay more attention to the high-incidence area of www.nature.com/scientificreports/. These areas should be carefully treated during surgery to avoid the possibility of postoperative strabismus
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