Review of orbital fractures in an urban level I trauma center

Abstract

Purpose Orbital fractures are not uncommonly encountered in a level I trauma center. The incidence of adult orbital fractures in the United States is 10% to 25% among all facial fracture cases. Craniomaxillofacial trauma is typically managed by 3 different surgical specialties (Oral & Maxillofacial Surgery [OMFS], Otolaryngology [ENT], and Plastic & Reconstruction Surgery [PRS]). The purpose of our study was to understand the patterns and mechanisms of injury associated with orbital fractures and to develop standardized treatment protocols across all surgical specialties. Methods This was a retrospective chart review of patients who sustained orbital fractures that were surgically repaired at the Emory University Grady Memorial Hospital (GMH) between January 2012 and December 2016. The study inclusion criteria were (1) diagnosis of an orbital floor fracture, (2) age 18 years and greater, (3) treatment provided at the GMH by the craniomaxillofacial trauma team. Exclusion criteria were patient age less than 18 years and absence of surgical intervention. The predictor variables were (1) demographic characteristics, (2) injury detail, (3) involvement of other facial fractures, and (4) treatment variables. Patients were deidentified before data analysis. Statistical analysis was performed with χ2, Mann-Whitney U, and Kruskal-Wallis tests. Analyses were performed with the SPSS software (SPSS Inc., Chicago, IL), and P value of Results The initial chart review yielded 689 patients. Of these, 173 patients had been diagnosed with orbital fractures and met the inclusion criteria. The average patient age was 41.6 years, and most were males, with a male-to-female ratio of 3.3:1. Most fractures were caused by assault (39.3%), and 22.5% of the cases were bilateral. The left orbit was fractured more often than the right (40.5%). The orbital floor was the most common anatomic location (97.1%), and the maxilla was the most commonly involved bone (65.3%). The average time from consultation to surgical intervention was 8.7 ± 14.6 days, and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision was the most commonly used incision (63%), and the nonresorbable implant was the most commonly used implant (92.7%). Finally, the length of stay for simple orbital fractures was less than that for complex orbital fractures, with 1.5 days and 5.9 days, respectively. Conclusions Among the 3 major specialties (OMFS, PRS, ENT), there is no consensus with regard to the management of orbital fractures. Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for the uniformly high quality of surgical care for patients with maxillofacial fractures.