Abstract
In this prospective study (2014 - 2016) we treated 29 patients with blow-out fractures. 18 (62%) were treated conservatively and in 11 (38%) we proceeded surgically. We decided whether surgical or non-surgical therapy was appropriate on the basis of clinical ENT, eye examination and the total volume of prolapsed orbital soft tissue. All procedures were perfomed by the same operating team with a uniform subciliary approach and using PMR splints adapted to the correct size and shape. On the basis of the mathematical model we reassessed findings in 2 patients: in one we decided against a surgical solution and in the other a surgical approach was indicated. All 18 patients treated conservatively, fully recovered and are free of diplopia. The 11 operated patients are also free of diplopia, only 1 patient (3%) displays clinically insignificant postoperative diplopia in extreme posisitons when looking upwards. With proper selection of the optimal treatment, the rate of complete disappearance of diplopia and fully preserved motility of the eyeball ranges from 91 to 97%. Surgical treatment of orbital floor fractures is important, mainly to minimise persistent post-traumatic diplopia which significantly reduces a patient's quality of life.
Highlights
Clinical symptoms of blow-out fractures may be seen in various combinations, but fracture symptoms are sometimes very poorly visible
We focused on the creation of new quantitative indication criteria for surgical therapy by calculating the volume of proplapsed soft tissues of the orbit and determining the critical values[3,4]
To use a mathematical model to calculate the volume of prolapsed soft tissue of the orbit in blow-out fractures of the orbital floor as an indication criterion for treatment
Summary
Clinical symptoms of blow-out fractures may be seen in various combinations, but fracture symptoms are sometimes very poorly visible. The presence of an orbital floor fracture, its size and weight, are determined by CT imaging (coronal and sagittal sections) and mathematical calculation of the volume of prolapsed soft orbital tissue. On the basis of our previous retrospective study, we identified two critical volumes for indicating surgical treatment in blow-out fractures: 500 mm[3] in anterior and posterior fractures and 1400 mm[3] in anteroposterior fractures. We focused on the creation of new quantitative indication criteria for surgical therapy by calculating the volume of proplapsed soft tissues of the orbit and determining the critical values[3,4]
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