Orbital Blowout Fracture Repair Research Articles

Long-term outcome following surgical repair of orbital blow-out fractures

Long-term outcome following surgical repair of orbital blow-out fractures

Diplopia After Surgical Repair of Orbital Floor Fractures

Blowout fractures of the orbit are common sequelae to blunt facial trauma. Many aspects of this injury have been studied, in particular, the timing of and indications for surgical intervention. Although diplopia is often an indication for surgery and is presented to patients as a potential postoperative complication, the incidence of diplopia after surgical repair of orbital blowout fractures has not been well studied. We retrospectively studied 54 patients who underwent repair of an orbital blowout fracture. A minimum of 6 months follow-up was available for all patients included in the study. A total of 47 of 54 (86%) patients had clinically significant diplopia preoperatively, and 20 of 54 (37%) remained diplopic. A total of 17 of 54 (31%) fractures involved the medial wall and orbital floor, and 13 of these 17 patients (86%) had postoperative diplopia. Patients with combined orbital floor and medial wall fractures appear to be at higher risk for clinically significant diplopia postoperatively than those with fractures of the orbital floor only. The explanation for this observation may be related to a greater difficulty in restoring the preoperative contour of orbits with combined fractures.

Controversies: Autogenous, alloplastic, integrated and resorbable implants for orbital blow-out fracture repair: A review

Controversy surrounds the selection of orbital implants used for the repair of orbital blow-out fractures. No less than 20 alloplastic, autogenous, resorbable or integrated materials have been reported for use in these repairs. Little information is available comparing the benefits, complications or selection criteria for these materials. This brief review will address the types of implants available, their reported complications, and potential clinical advantages and disadvantages to construct a rational approach for the selection of an implant for orbital fracture repair.

Conjunctival Approach를 사용한 안와저 분쇄골절의 수술적 치료

There are four approaches described for the repair of orbital blowout fractures—transantral, skin-orbicularis oculi muscle flap through a subciliary incision, horizontal lower lid incision over the infraorbital rim, and conjunctival approach. Conjunctival approach to the orbital floor and infraorbital rim has been a safe and reliable technique. In addition to improved cosmesis, the conjunctival approach has essentially eliminated the complications of ectropion and scleral show, which frequently occur following the precutaneous, subciliary approach. Recently 2 years, the preseptal conjunctival approach has been used in 11 patients. No loss of vision, persistent diplopia secondary to surgery, corneal abrasions, ectropion, or other complications occurred in our cases.

Orbital and adnexal trauma

Trauma to the canalicular system must be suspected in medial eyelid lacerations. When a laceration of the canaliculus is diagnosed, every attempt should be made to repair the canaliculus within the first 48 hours following the injury; epiphora may result from loss of the canaliculus, even if the opposite canaliculus remains intact, and late repairs are much less likely to result in a functioning tear outflow system. The surgeon should have an armamentarium of various techniques for canalicular repair. The pigtail probe, used with a delicate touch and immediately abandoned if smooth passage is not obtained, can be a very useful tool in these injuries. The main goals of orbital blowout fracture repair are prevention of late enophthalmos and ocular dystopia, and minimization of late restrictive motility defects. The availability of high-resolution orbital imaging studies has eliminated some of the uncertainty that used to characterize surgical decision making in isolated orbital blowout fractures. It is now possible to identify large fractures with significant expansion of orbital volume that will lead to enophthalmos and ocular dystopia; these patients are surgical candidates, and there is no advantage to delay. Patients with ocular motility disturbance and diplopia following orbital blowout fractures are significantly more complicated with regard to surgical decision making. There is no expert consensus and there are no good published data to provide absolute guidelines. The factors that militate in favor of surgical intervention include diplopia in the primary fields of gaze persisting beyond 1 to 2 weeks without improvement, positive forced duction testing, and evidence of soft tissue incarceration on orbital imaging studies. Fractures that involve the extended orbit, including the nasoorbitoethmoid region and the orbitozygomatic region, require surgical management when significant displacement of the bony fragments is diagnosed on orbital imaging studies. The availability of modern bone fixation systems and increasing use of wide subperiosteal exposure of all displaced fractures minimize the incidence of late orbital dystopia, telecanthus, asymmetry, and abnormal soft tissue scarring, which typically result from inadequately reduced orbital fractures. Ophthalmologists should be cognizant of the optimal methods for diagnosis and treatment of orbital fractures; those with orbital surgical training are particularly well prepared, based on their extensive knowledge of orbital anatomy and physiology, to serve as “captains” of the multidisciplinary team typically involved in the management of complicated midfacial fractures.

Management of blow-out fractures of the orbital floor: III. The conservative approach

The management of orbital fractures has long been controversial. In some cases, surgical repair is required, and early repair is more successful than secondary reconstruction. In other cases, slow resolution of diplopia over four to six months obviates surgery. In an editorial and two separate articles, the authors elucidate indications for and results of the early vs. late surgical repair of orbital blow-out fractures.

Management of blow-out fractures of the orbital floor: II. Early repair for selected injuries

The management of orbital fractures has long been controversial. In some cases, surgical repair is required, and early repair is more successful than secondary reconstruction. In other cases, slow resolution of diplopia over four to six months obviates surgery. In an editorial and two separate articles, the authors elucidate indications for and results of the early vs. late surgical repair of orbital blow-out fractures.

Orbital blowout fractures — the influence of age on surgical outcome

We report the frequency of troublesome diplopia in 17 patients (11 patients less than or equal to 21 years) who underwent surgical repair of traumatic orbital blowout fractures. Thirteen patients had primary surgery performed within 21 days of injury, 2 patients at 4 and 6 weeks and 2 cases at 6 and 24 months. The latter continues to complain of diplopia. Contrary to previous studies, we found that young patients were no more likely to suffer from symptomatic post-operative residual diplopia than their adult counterparts.

Athletic Facial Injuries: Call in Everyone-Reply

In Reply.— Several of the respondents criticized the scope of the manuscript. This particular review article could not possibly include all ophthalmologic, otolaryngologic, and neurological injuries. We presented instead a brief overview of common maxillofacial injuries in the athlete. A more comprehensive presentation will be available later this year in a textbook on sports injuries edited by Kenneth DeHaven, MD. In one publication we have combined our efforts with other specialists from otolaryngology, oral surgery, and ophthalmology to give a more comprehensive review of these injuries. The letter by Dr Wesley refers to the controversy surrounding the treatment of orbital floor fractures. Although some authors favor nonoperative management, we prefer early exploration and repair of orbital blowout fractures. This approach reduces the long-term sequelae such as diplopia and enophthalmos and restores the continuity of the orbital floor. Early intervention minimizes the fibrosis and shortening of extraocular muscles and globe-supporting septa

Athletic Facial Injuries: Call in Everyone

To the Editor.— The article by Drs Schultz and de Camara 1 provided an excellent review of athletic facial injuries. However, the statement that of orbital floor fractures consists of surgical exploration and repair of the floor with either a Silastic sheet or cortical bone graft can be misleading. While floor fractures associated with rim fractures may require repair, most pure orbital blowout fractures require no repair. In fact, orbital exploration and placement of foreign material exposes the patient to potential complications. No two orbital surgeons in this country will agree on the exact indications for orbital blowout fracture repair, but readers should understand the treatment of each pure orbital blowout fracture requires individualized evaluation.

Unusual complication of orbital floor blow-out fracture repair

Unusual complication of orbital floor blow-out fracture repair