Association of Midfacial Fractures with Ophthalmic Injury

Abstract

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women. The main cause of trauma was road traffic accidents. Forty-one patients suffered an ophthalmic injury following the fracture. Twelve of them had a persistent ophthalmic problem. Ophthalmic examination is necessary during the initial management. The time window for preservation of sight is small and treatment should be started immediately. Development of an emergency trauma scale that includes fractures, symptoms of visual impairment, and patient history is recommended and should stimulate a multidisciplinary approach of complex cases.

Pattern of ocular involvement in midface injuries seen at a tertiary care hospital in northern Nigeria

“…In literature, between 38.7% and 95.7% of patients with midfacial fractures also have ocular injuries. [ 4 6 11 ] In our study, 85.5% of the patients with midfacial injuries had ocular injuries, showing the importance of proper diagnosis of ocular injuries in patients with injuries to the midface. With respect to demographics, there were more males (83.8%) than females (16.2%), with most patients (38.7%) aged between 21 and 30 years of age [ Table 1 ].…”

“…This is similar but much higher than other reports where between 43.3% and 77.0% of midfacial injuries were due to RTAs. [ 7 9 10 11 ] While the second most common etiology in our study was assault or interpersonal violence (IPV) (4.7%), followed by animal injury (2%) and falls (1.3%) [ Table 1 ], most other studies[ 7 9 10 11 ] reported falls (23.5%–32.0%), followed by IPV (6.9%–21.0%).…”

“…This agreed with most reports on ocular injuries associated with midfacial injuries. [ 6 10 11 ] However, Politis et al . [ 11 ] found the 41–50 years' age bracket as most affected (18.9%) in a Belgian study.…”

“…[ 6 10 11 ] However, Politis et al . [ 11 ] found the 41–50 years' age bracket as most affected (18.9%) in a Belgian study. The older age group in the Belgian study could be a reflection of the aging pattern of the population as compared to those in socioeconomically less developed economies.…”

“…In the midface, fractures of zygomatic complex (62.0%), followed by Le Fort II (27.0%) and orbital wall fractures (13.9%), were the most common causes of ocular injuries, according to Mohanavalli et al .,[ 10 ] while Politis et al . [ 11 ] found that those of the maxillary sinus (44.3%), followed by those of the orbital walls (23.6%) and zygoma (23.6%), were the common causes of ocular injuries. Table 2 shows that zygomatic complex fracture (38.6%), followed by those of the orbital walls (24.7%) and Lefort II fracture (15%), were commonly associated with ocular injuries.…”