Ophthalmic Complications Associated with Zygomatic Complex Fractures: A Randomised Descriptive Clinical Study.

Abstract

Trauma to the maxillofacial region is usually associated with varying degrees of disruption of the soft and hard tissues in the region and injuries to the neighbouring structures such as eyes, brain, nasal apparatus and paranasal sinuses. Injuries to the middle third of the face commonly destroys the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 67% as reported in the literature. These injuries may result in loss of vision or compromised ocular function. When these injuries are severe, they may be detected with ease by any medical or maxillofacial surgeon but many injuries appear minimal and may be missed by the non-ophthalmologist. A total of thirty patients were selected who were diagnosed with a zygomatic complex fracture, irrespective of sex predilection and in the age group of 18-70years. All patients underwent a thorough ophthalmic examination by an Oral and Maxillofacial Surgeon and an Ophthalmologist preoperatively and on postoperative day 2, and 7 and all findings were documented separately by the surgeon and the ophthalmologist and the findings were later compared. The statistical analysis was performed using SPSS VERSION 21.0, Shapiro-Wilk test which was used to assess the normality. Descriptive analysis was done for age and gender distribution of study subjects, which are expressed as number and frequency. Cochran's q test was used to determine if there are differences in various study factors among OMFS and ophthalmologists at three time intervals which are expressed as number and frequency. Kappa agreement was used to assess the measurement of agreement between OMFS and ophthalmologists for each factor at each time interval and these are expressed as number and frequency, and p ≤ 0.05 is considered as statistically significant. Upon examination by an OMFS periorbital oedema (p = 0.000), periorbital ecchymosis (p = 0.002), chemosis (p = 0.02) and exophthalmos (p = 0.03) were considered clinically significant. Upon examination by an ophthalmologist subconjunctival haemorrhage (p = 0.05), periorbital oedema (p = 0.05), periorbital ecchymosis (p = 0.00), ptosis (p = 0.006), enopthalmos (p = 0.05) and diplopia (p = 0.05) were considered to be clinically significant. Upon correlation of the findings of the surgeon and the ophthalmologist it was seen that certain parameters like corneal injury, Phthisis bulbing, examination of posterior segment can be better done by the ophthalmologist. In conclusion, it was determined that there is a significant correlation between ophthalmic injuries caused by zygomatic complex fractures. There are a wide array of injuries affecting the eye due to trauma to the middle third of the face, and the superficial injury can be well evaluated and documented by a surgeon; however due to the extensive nature of the injuries in trauma and the importance of the eye, an ophthalmic examination cannot be ruled out. The need for evaluation of such injures deem it pertinent for observation by an ophthalmologist.