Survey of Oral and Maxillofacial Surgeons on Area and Volume Changes in Orbital Floor and Medial Wall Defects

Abstract

Criteria for surgical repair of isolated orbital floor and medial wall defects when no functional deficits are present is controversial and based on various methods of calculating critical defect size that, if untreated, could result in enophthalmos.1 There have been surveys in the United States, United Kingdom, and other countries reporting on materials and surgical technique in isolated orbital floor fractures; however, to date, no survey has been completed that focuses on specific metrics practicing oral surgeons use in determining if surgery is recommended.2 The purpose of this research was to anonymously survey oral and maxillofacial surgeons to determine the most frequently utilized metrics and methods currently used in practice for determining the necessity of a surgery when functional and/or cosmetic defects are not present. An anonymous survey was sent to United States oral and maxillofacial residency programs and private practicing surgeons who perform surgical orbit fracture repairs. The survey was designed to determine which radiographic features the participant preferred when determining whether to recommend surgical correction and the methods they used to procure these measurements. Each question was analyzed individually. Initial results showed that over 75% surgeons preferred to use an area measurement of “greater than 50% of the floor” when using area as a predictor; however, there was a stark disagreement between participants when deciding if area or volume was more important, with participants equally split between the 2 factors. The more years the participant has been in practice was more closely associated with using area instead of volume. Using a clinical example, over 50% of the participants recommended surgery to a patient when defect alone would be the determining factor. These results are unsurprising given the surplus of literature available that speaks on controversies regarding defect size and surgical repair. This survey helped illuminate what metrics surgeons are currently using to measure defect and recommend orbital surgery when defect size becomes the main determinant. The extent of disagreement between surgeons illustrates the need to validate an optimal, universally accepted method for determining and measuring critical-size defects in surgical decision-making.