Orbital Wall Fracture Research Articles

Multicentric Epidemiological Analysis on Medial Wall Fractures of the Orbit: 10‐Year Retrospective Study Between the Centres of Perugia and Ancona

ABSTRACTStudy Design and ObjectivesThe incidence of isolated fractures of the orbital medial wall is moderate because of the low bone thickness. Our study aimed to investigate demographic variables, fracture features and statistical correlations associated with these fractures retrospectively.Materials and MethodsA total of 57 patients with isolated orbital medial wall fracture, admitted at the Maxillofacial Surgery Unit of Perugia University Hospital and Maxillofacial Surgery Unit of Ospedali Riuniti di Ancona, from 2014 to 2023 were enrolled in the study.Age, sex, comorbidities, post‐traumatic clinical manifestations and defect size and side were all evaluated in patients. Pearson's regression coefficient (r) was used for statistical analysis.ResultsThe fractures were more frequent in men (male to female ratio 2.16:1) primarily as a result of motor vehicle accidents (30% of cases); the average age was 48 years; enophthalmos, diplopia and ocular motility abnormalities were observed in 31%, 23% and 21%, respectively.According to statistical analysis, fracture area was significantly correlated with age, with older patients having larger fractures (p < 0.001); interpersonal violence and traffic accidents were related to younger age (p < 0.001). In a recent analysis of the data, it was found that isolated orbital medial wall fractures occur more frequently in young men (< 40 years) due to road accidents or interpersonal violence. Patients' age is statistically correlated with fracture area, with older patients having larger defects.ConclusionsThis research assesses both the demographic and fracture characteristics of pure medial orbital wall fractures, aiming to enhance the understanding of this clinical scenario and to evaluate optimal treatment strategies.

Age-stratified anatomical differences of orbital floor and medial orbital wall blowout fractures.

To define the anatomical variance between orbital floor and medial orbital wall blowout fractures, and its change with age. This was a retrospective, observational study analyzing data from 557 patients with isolated blowout fractures of the orbital floor or medial orbital wall. Axial and quasi-sagittal CT images were analyzed to compare radiologic data on orbital wall morphology between fracture site groups and among age groups. Patient ages were classified as: 0-9 (childhood), 10-18 (adolescence), 19-44 (early adulthood), 45-64 (middle adulthood), and ≥ 65 years (late adulthood). The orbital floor fracture group demonstrated significantly steeper orbital floors (p < 0.001), while the medial wall fracture group exhibited a tendency for more convex medial orbital walls (p = 0.066). Among age groups, medial wall fracture was predominant in the late adulthood group only (p < 0.001). Patients in the childhood and late adulthood groups had significantly flatter orbital floors (p < 0.001). Patients in the childhood group presented with a concave medial orbital wall (p < 0.001). The anteroposterior length of the medial orbital wall and the number of ethmoid air cells were not different between fracture groups (p = 0.603 and0.753, respectively) and among age groups (p = 0.306 and0.456, respectively). Patients with orbital floor and medial orbital wall fractures had anatomically steeper orbital floors and convex medial orbital walls, respectively. Age-related differences in the shape of the orbital walls may influence variation in orbital blowout fracture sites by age. WHAT IS KNOWN : Fracture sites of the orbital walls differ according to age groups. The floor is morecommonly fractured in children, with a shift to the medial wall in the elderly. Orbital floor and medial orbital wall fractures present with anatomically higher floor and medial walls, respectively, compared to each other. This indicates steeper convexities of the walls which predispose them to fracturing. Children's medial orbital walls are initially concave, then shift to convex structures with facial bone and sinus maturation. This explains why there is a change in blowout fracture site between age groups, as it has been documented that concave structures are more resistant to deformation.

Concomitant Traumatic Macular Hole and Orbital Fracture.

To report 5 cases of concomitant traumatic macular hole (TMH) and orbital fracture, and discuss its incidence. This was a retrospective, observational study including all patients with orbital fracture who were referred to us from May 2013 to December 2023. Axial and coronal orbital computed tomographic images with bone and soft tissue window algorithms and optical coherence tomographic images were obtained from all patients. Among 1171 sides from 1152 patients with pure orbital blowout fractures, we found 5 sides from 5 patients (0.4%) with concomitant TMH. All trauma was caused by baseball/softball injury. One patient had a medial orbital wall fracture with TMH stage 1b. Two had orbital floor fracture with TMH stages 2 and 3. The other two had both orbital floor and medial orbital wall fractures with TMH stages 3 and 4. Orbital fracture was reduced in 3 patients. Two had spontaneous closure of TMH with no improvement in visual acuity, while one improved with pars plans vitrectomy and internal limiting membrane peeling. The incidence of concomitant TMH and orbital fracture is only 0.4%. The rarity of this association supports the protective role of orbital fractures in blunt trauma. Specific mechanisms of trauma, such as impacts from baseballs and softballs, may increase risk of such injuries.

Associations between socioeconomic status and open globe injury.

To examine associations between socioeconomic status (SES), as evaluated by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) and Distressed Communities Index (DCI), and the characteristics of open globe injury (OGI). Retrospective review of electronic medical records for patients treated for OGI at an academic Level I trauma centre between May 2009 and March 2021. Patient data included age, date of injury, mechanism of injury, visual acuity at presentation, concomitant orbital wall fracture, and ocular trauma score (OTS). The SVI and DCI scores were obtained based on the patient's home zip code. Patients were classified based on individual mechanisms of injury and grouped into non-accidental vs. accidental cases. 899 patients (75.0% male) were included. Average ± SD age (years), SVI, and DCI scores were 44.8 ± 22.7, 0.418 ± 0.207, and 37.9 ± 24.0, respectively. Younger age was associated with higher DCI and lower OTS score (p ≤ 0.002). Non-accidental trauma patients had lower OTS and higher SVI and DCI scores compared to accidental trauma (p < 0.001); firearm-associated ocular injuries (FAOIs) were associated with higher SVI and DCI scores (p < 0.001 and p = 0.040, respectively); domestic violence/assault was associated with worse OTS and higher DCI (p < 001). Falls and sports-related injuries correlated with lower DCI scores (p ≤ 0.031). In our region, among patients with OGIs, lower SES scores were associated with younger age, FAOIs, and non-accidental injuries, including domestic violence/assault. Therefore, lower SES may be considered a risk factor for several distinct mechanisms of OGI.

Volumetric Analysis of Orbital Volume Discrepancy as a Marker of Change in Globe Position After Three-Point Fixation of Zygomatic Complex Fractures

BackgroundMany researchers have proposed incorporating orbital volume (OV) discrepancies between the affected and unaffected orbits into routine diagnostic processes as an indicator for early surgical repair of zygomatic complex fractures (ZMCFxs) to avoid postoperative ocular complications. PurposeThe study aimed to determine the correlation between the preoperative OV discrepancy and postoperative globe position. Study Design, Setting, SampleA retrospective cohort study was performed on patients with unilateral ZMCFxs associated with orbital floor fractures, treated at Al-Zahraa Hospital, Al-Azhar University, from January 2020 to July 2023. Patients with comminuted ZMCFxs, medial or superior orbital wall fractures, or corrective surgeries were excluded. Predicator VariableThe predictor variable was the preoperative OV discrepancy between the affected and unaffected orbits. Outcome VariablesThe outcome variables were the three-month postoperative globe position, which was classified as normal, enophthalmos, or exophthalmos, and the orbital repair quality, that was categorized as well-corrected, under-corrected, or over-corrected. CovariatesThey included age, sex, ethnicity, side, etiology, type of orbital floor fractures, timing, and indication for surgery. Statistical AnalysisChi-square, Pearson's correlation, and linear regression analyses were used; the statistical significance was set at P < .05. ResultsThe study included 111 patients, with an average age of 30.3± 6.6 years and male predominance. The preoperative OV discrepancy between both orbits was 5.1± 1cc3, associated with enophthalmos in the patients. Postoperatively, the OV discrepancy became 0.9± 0.7 cc3, but the globe position was heterogenic. Thirty-seven patients (33.3%) had normal globe position. Sixty-three (56.8%) subjects had enophthalmos. Eleven (9.9%) individuals had exophthalmos. The preoperative OV discrepancy and postoperative globe position had a significant weak positive linear correlation. For every one-cubic-centimeter change in OV, the globe moved 0.1mm (P< .05). The majority of the patients had under-corrected orbits, followed by over-corrected and well-corrected orbits. Every category of globe position was recorded with every category of orbital repair, and the findings showed no correlation between globe position and orbital repair quality (P= .08). ConclusionPreoperative OV discrepancies between both orbits should not be employed as the sole predictor of globe position because a one-cubic-centimeter change in OV affects globe position by only 0.1mm.

A New Approach for Orbital Wall Reconstruction in a Rabbit Animal Model Using a Hybrid Hydroxyapatite-Collagen-Based Implant.

Reconstructing the orbit following complex craniofacial fractures presents significant challenges. Throughout the years, several materials have been used for orbital reconstruction, taking into account factors such as their durability, compatibility with living tissue, cost efficiency, safety, and capacity to be adjusted during surgery. Nevertheless, a consensus has not yet been reached on the optimal material for orbital restoration. This study investigates the potential of a hybrid hydroxyapatite-collagen (HAp-COL) material 3D-printed on Ti mesh to be used as an implant for orbital wall reconstruction. HAp-COL powder was synthesized using a high-pressure hydrothermal technique. The powder was further used to 3D-print HAp-COL structures on titanium mesh, with the latter having potential uses in orbital wall reconstruction. Biocompatibility was assessed by evaluating the effects of the HAp-COL material on the adhesion and proliferation of fibroblasts (3T3) and mesenchymal stem cells (MSCs) in culture. In vitro and in vivo results showed that HAp-COL is highly biocompatible and has a good integration of the implant in the bone. The findings reported in this study offer convincing evidence to support the use of our designed HAp-COL for the restoration of orbital wall fractures, with a high level of safety.

A case report and systematic review of periorbital emphysema following nose blowing or sneezing.

Periorbital emphysema following nose blowing or sneezing is rare. Although it is often self-limiting, air trapping in the orbit can raise the intraocular pressure leading to visual complications. At present, the literature on this topic is confined to case reports. In this article, we present a rare case of periorbital emphysema following nose blowing in a 34-year-old woman and a subsequent systematic review that included 43 case reports of periorbital emphysema following similar mechanisms. Orbital wall fracture was seen in 70% and a defect in the lamina papyracea is the most common finding on computed tomography imaging. Surgical intervention was performed in 30% of patients; indications included visual compromise, paranasal osteoma and inflammatory disease. Most patients can be safely discharged on the same day with oral antibiotics unless there are clinical signs of visual compromise or sinonasal mass that may necessitate surgical intervention. The recurrence rate is low (3%) and almost all will resolve within 4 weeks.

Accuracy of the Image Interpretation Capability of ChatGPT-4 Vision in Analysis of Hess Screen and Visual Field Abnormalities.

OpenAI, the owner of ChatGPT, publicly released the GPT-4 Vision in September 2023. This multimedia chatbot has the capability to receive and analyze various images presented to it by the user. We assessed the accuracy of its interpretation of 2 of the images commonly used in neuro-ophthalmology, namely Hess screen and automated visual field images. We separately uploaded typical images of 5 abnormal Hess screen charts related to third, fourth, and sixth cranial nerve palsy, Brown syndrome, and inferior orbital wall fracture with entrapment of the inferior rectus muscle. Likewise, 5 classic images of automated visual field grayscale maps related to lesions of the optic nerve, the chiasma, the optic tract, the optic radiations, and the occipital lobe were presented. The chatbot was instructed to select the best option among the 5 choices presented in each question. The GPT-4 Vision was able to select the right choice in 2/5 questions on Hess screens and 3/5 of the visual field questions. Despite selection of the correct option, qualitative evaluation of GPT-4 responses revealed flawed analysis of certain aspects of some image findings, such as the side of involvement or the misinterpretation of the physiologic blind spot as a central scotoma. The performance of GPT-4 Vision in the interpretation of abnormalities of Hess screen and visual field involvement was highly variable, even with simple typical cases of classic disorders. As the chatbot's image recognition is currently evolving, its capacity to accurately interpret ophthalmologic images is still limited at this time.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies

BackgroundTraumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study investigated the predictive risk factors for TON and analyzed the effectiveness of current treatments with respect to visual outcomes in patients with TON. MethodsThis study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score (ISS) were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity. ResultsThis study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥ 4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, mega-dose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression. ConclusionClinicians can achieve early prediction of TON in patients with an initial unconscious state and the determined risk factors. The results indicated that conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

Computed tomography of acute orbital trauma in children: a retrospective study

INTRODUCTION: Orbital injuries account for 36 to 64% of all blunt trauma to the facial bones. Diagnosis of orbital wall fractures is carried out using conventional radiography in several projections and computed tomography; magnetic resonance imaging is less commonly used. Often, due to the small displacement of orbital bone fragments, X-ray diagnosis is difficult. Multislice CT with reconstruction of sagittal, coronal projections and 3D in the bone window in such cases is the best visualization method. However, there are still no clear indications for the use of each method and there is no complete view of the CT characteristics of orbital damage.OBJECTIVE: To study the diagnostic value of computed tomography of orbital fractures in pediatric patients with acute trauma.MATERIAL AND METHODS: Retro- and prospectively analyzed the results of CT scans of 94 patients with facial fractures from 01/01/2023 to 09/01/2023 to assess combined orbital injuries. Orbital fractures were detected in 63 children (67.0%). There were 44 boys (69.84%), 19 girls (30.15%) aged from 7 months to 17 years 10 months (average age 10.3). Statistics: For statistical analysis, the method of calculating the nominal correlation using the Kramer coefficient (V) using the IBM SPSS Statistics software package was used.RESULTS: Concomitant injury was observed in 30 (47.6%); isolated 33 (52.36%). The number and frequency of fractures observed were as follows: superior wall of the orbit — 39 (61.9%); zygomatic complex — 19 (30.1%); lower wall of the orbit — 43 (68.2%); nasal bone — 17 (26.9%); lower jaw — 6 (9.5%); medial wall of the orbit — 28 (44.4%); upper jaw — 27 (42.8%); alveolar process — 6 (9.5%); isolated zygomatic arch — 14 (22.2%); Le Fort type I — 1 (1.5%); Le Fort type II — 2 (3.1%); and Le Fort type III — 0 (0%). Orbital hematomas were found in 25 patients (39.6%). It was revealed a strong correlation between the presence of contiguous skull fractures and multiple skull fractures (V=0.878, p&lt;0.001), frontal sinus fractures and frontal sinus hemosinus (V=0.69, p&lt;0.001).CONCLUSION: Orbital fractures are a frequent type of facial fracture occurring in children with blunt isolated and combined trauma. In children with blunt trauma, head CT combined with clinical examination is currently the optimal tool for diagnosing clinically significant orbital injuries. There is a strong correlation between orbital hematomas and orbital vault fractures, orbital hematomas and lattice fractures, adjacent skull and orbital vault fractures, and adjacent skull and lattice fractures. CT examination should include multiplanar (in coronal and sagittal planes) and 3D reconstructions, which help to assess the extent of the fracture, the presence of diastasis, the degree of muscle impingement. Based on the data obtained, the clinician determines the need for surgical intervention.

Assessing the need for specialty consultation for isolated medial orbital wall fractures

ObjectiveThis objective was to assess if the current practice of interfacility transfer and immediate specialty consult is justified by the rate of surgical repair for isolated medial orbital wall fractures. Study DesignThis is a retrospective descriptive study utilizing the records of all patients with isolated medial orbital wall fractures who presented to the ED at Boston Medical Center from January 2014 to December 2022. A descriptive analysis was completed. Results65 patients with isolated medial orbital wall fractures were identified. No patient underwent surgical intervention for repair of their fracture. 15% of the patients were transferred from an outside facility. The facial trauma team was consulted for 70% of the patients. Concomitant consultation of the ophthalmology and facial trauma teams occurred for 54% of the patients. Patients with no specialty consult had the shortest average length of ED stay. The no-show rate for follow-up appointments was 70%. ConclusionsThe absence of surgical repair for isolated medial orbital wall fractures across multiple surgical specialties, multiple attending providers, a wide age range, and all mechanisms of injury along with a 70% follow-up no-show rate may call into question the conventional approach of interfacility transfer and specialty consult for these fractures.

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall.

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

Exploring 3D Printed Implants With Anti-Dropout Function to Overcome Time Constraints in Acute Orbital Fractures for Patient-Specific Implants.

Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1mL) and exophthalmos (<1mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.

Efficacy of Fat and Perifascial Areolar Tissue Graft in Refractory Esotropia: A Case Report

Purpose: This case report presents a novel approach for the management of refractory esotropia using adhesiolysis and fat and perifascial areolar tissue (PAT) transplantation.Case summary: A 62-year-old male presented with left eye strabismus fixus following iatrogenic medial rectus (MR) muscle injury and medial orbital wall fracture during endoscopic sinus surgery. One month later, he underwent MR laceration repair and orbital wall reconstruction. Despite three subsequent interventions for exotropia and its subsequent conversion to esotropia, the left eye esodeviation progressively worsened, culminating in strabismus fixus. Initial examination revealed significant left eye esotropia with fixed gaze and 5-mm enophthalmos. Surgery included implant removal, adhesiolysis between the eyeball and surrounding tissues, scar and MR recession, and placement of a fat and PAT graft on the medial aspect of the eyeball to prevent postoperative re-adhesion. Three years of follow-up demonstrated sustained orthophoria in primary gaze with improved extraocular muscle function and enophthalmos.Conclusions: Fat and PAT graft has potential in oculoplastics for preventing re-adhesion and augmenting orbital volume in patients with refractory restrictive strabismus due to multiple surgeries.

Serial Case of CT Scan Imaging in Fracture of Midface Region

Background: Fractures in the face region are frequently seen in motor vehicle accidents, as the face is highly exposed during such incidents. Motor vehicle accidents are common in Bali, with fracture of the face region is the 2nd most common injury found in radiologic examination. Computed tomography (CT) scans are crucial for assessing these fractures, allowing for an accurate evaluation of severity to plan the patient treatment. Case: We present serial cases CT scan images of complex midface fractures such as Le Fort, tripod, NOE and orbital wall fracture and its characteristic imaging on CT-imaging. Conclusions: CT scan may guide treatment plans aimed at minimizing disability and enhancing the patient's quality of life. Understanding the imaging characteristics of midface fractures is thus essential for effective diagnosis and management.

Delayed-Onset Orbital Abscess After Orbital Blowout Fracture Repair Using Porous Polyethylene Implant.

This study aims at documenting a rare case of delayed-onset orbital abscess following the use of a nonabsorbable porous polyethylene implant in orbital fracture repair, highlighting the potential long-term risks associated with non-biodegradable orbital implants. A 44-year-old man presented with diplopia on down gaze, proptosis, and eyelid edema for 2 weeks. He had undergone repair of an inferior orbital wall fracture with a porous polyethylene implant 5 years ago. Computed tomography (CT) evaluation revealed a significant intraorbital abscess related to implant infection. Surgical interventions included abscess drainage and implant replacement, which led to patient recovery. Nonabsorbable implants, which are beneficial for orbital reconstruction, may pose a risk of occurrence of delayed infections several years following surgery. This report highlights the importance of long-term monitoring to mitigate the risks of potential late complications, which necessitate early diagnosis, appropriate intervention, and management strategies.

Biomechanical analysis of an absorbable material for treating fractures of the inferior orbital wall.

To investigate the biomechanical properties and practical application of absorbable materials in orbital fracture repair. The three-dimensional (3D) model of orbital blowout fractures was reconstructed using Mimics21.0 software. The repair guide plate model for inferior orbital wall fracture was designed using 3-matic13.0 and Geomagic wrap 21.0 software. The finite element model of orbital blowout fracture and absorbable repair plate was established using 3-matic13.0 and ANSYS Workbench 21.0 software. The mechanical response of absorbable plates, with thicknesses of 0.6 and 1.2 mm, was modeled after their placement in the orbit. Two patients with inferior orbital wall fractures volunteered to receive single-layer and double-layer absorbable plates combined with 3D printing technology to facilitate surgical treatment of orbital wall fractures. The finite element models of orbital blowout fracture and absorbable plate were successfully established. Finite element analysis (FEA) showed that when the Young's modulus of the absorbable plate decreases to 3.15 MPa, the repair material with a thickness of 0.6 mm was influenced by the gravitational forces of the orbital contents, resulting in a maximum total deformation of approximately 3.3 mm. Conversely, when the absorbable plate was 1.2 mm thick, the overall maximum total deformation was around 0.4 mm. The half-year follow-up results of the clinical cases confirmed that the absorbable plate with a thickness of 1.2 mm had smaller maximum total deformation and better clinical efficacy. The biomechanical analysis observations in this study are largely consistent with the clinical situation. The use of double-layer absorbable plates in conjunction with 3D printing technology is recommended to support surgical treatment of infraorbital wall blowout fractures.

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut.

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.

Neglected Superior Ophthalmic Vein Enlargement before Delayed Symptom of Carotid-Cavernous Fistula in a Blowout Fracture: A Case Report and Literature Review.

Carotid-cavernous fistula (CCF) is a rare condition. However, it should be suspected when there are traumatic facial fractures, because if not diagnosed, it can lead to permanent damage such as blindness. Traumatic CCF often presents delayed symptoms, and delayed diagnosis without prompt treatment can lead to permanent injuries in optic and cranial nerves III, IV, V, and VI as well as intracranial hemorrhage. The routine initial modality for patients with suspected facial bone fractures is noncontrast computed tomography (CT) to identify any fracture lines and check for intracranial hemorrhage. We report a post-traumatic CCF case with a 4-day symptom delay, where left superior ophthalmic vein (SOV) enlargement was observed on the routine noncontrast facial CT with ipsilateral orbital wall fracture. When the patient first presented to the emergency room (ER), we did not detect vein enlargement on CT. Afterwards, the patient developed delayed symptoms of CCF and was readmitted to the ER. When we reanalyzed the first CT scan, an enlarged SOV was confirmed. The diagnosis was confirmed via magnetic resonance imaging angiography, and the patient was successfully treated with embolization of the fistula. Thus, we recommend reviewing ophthalmic vein enlargement that is readily identifiable through noncontrast CT for patients injured by craniofacial trauma to suspect the presence of delayed CCF at their initial presentation.