Abstract
ObjectiveThe 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 designOne 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.ResultsThe 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 average orbital wall defect size was 297.9 mm2 (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.ConclusionResults of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm2.
Highlights
Epidemiological studies involving 600 hospitals in Germany from the TraumaNetzwerk D GU® reported from a pooled number of patients of 102,887, that 11,451 (11.1%) suffered from facial trauma [1]
There was a positive correlation between the male gender (p ≤ 0.001; r = 0.34; n = 1594) and a younger patient age (p ≤ 0.001; r = 0.34; n = 1594) and physical assault as the cause of injury
Older patient age strongly correlated with accident or falls as the cause of injury (p ≤ 0.001; r = 0.58; n = 1594)
Summary
Epidemiological studies involving 600 hospitals in Germany from the TraumaNetzwerk D GU® reported from a pooled number of patients of 102,887, that 11,451 (11.1%) suffered from facial trauma [1]. The orbit is especially susceptible to injury because of its very complex anatomical structure with hard and soft tissue. Blunt trauma in this facial region may cause an isolated orbital “blowout” fracture or a combined. General agreement that an acute loss of the visual function in the presence of a retrobulbar hematoma, severe enophthalmos, incarceration of peribulbar soft tissue and large defect sizes over 50% of the orbital floor require immediate surgical intervention to restore the anatomical structure of the orbit and improve the visual function as well as the orbital appearance [12,13,14]. There are a variety of surgical approaches to reconstruct the orbit. The unpredictable resorption rate as well as the missing optimal volume reconstruction led to the increasing use of resorbable alloplastic biomaterials, such as poly-p-dioxanon (PDS®) [20] (Fig. 2) and polyglactin (Ethisorb®) [21] and non-resorbable alloplastic materials, such as the titanium mesh (Fig. 3), which today can be individually preformed to the patients anatomy in a CAD-CAM process [22, 23]
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