Delayed Repair of Lateral Orbital Wall and Orbital Floor Fracture

Abstract

Timing of surgical management of facial fractures may differ from the current standard when an associated severe ophthalmologic injury exists; this may necessitate a delay in repair to protect the patient's vision. We set out to demonstrate that good functional and aesthetic outcomes can be achieved in cases where zygoma bone fracture repair had to be delayed for more than 21 days after injury with a specific surgical plan.Using the electronic database from Montreal General Hospital, a level I trauma center, a retrospective review of all facial fractures occurring from 1994 to 2009 was performed. Our review returned a total of 22,727 trauma patients admitted to Montreal General Hospital. Of these, 2672 sustained 1 or more facial fractures. Among the facial trauma patients, 945 patients' injuries included a zygoma fracture, 324 (35.3%) of which were managed operatively. Seven cases had their surgery delayed for more than 21 days after injury, 2 of which were managed using simple osteotomies and plate fixations, without the need for bone grafts. Both patients demonstrated a satisfactory outcome with improvement relative to their preoperative status. We provide a detailed description of our most recent case of a 73-year-old woman in whom the surgical repair of the lateral orbital rim and orbital floor was delayed for 10 weeks to allow healing of her associated traumatic retinal detachment.For patients with associated ocular injuries who cannot undergo orbital fracture repair within 21 days of the trauma, delayed surgery may still result in an acceptable aesthetic result.

A Review of Frontal Orbital and Frontal Sinus Fractures and Associated Ocular Injuries - Level I Trauma Center - University Hospital Experience

“…These include the fracture pattern, degree of posterior table involvement, nasofrontal duct injury, neurological status, concomitant head injury, presence of CSF leak, and retinal detachment, which may preclude surgical access to the patient. 7 This review demonstrates a relatively high proportion of severely obtunded patients who were treated conservatively (71%). Several factors accounted for the relatively low surgical intervention rate (29%), including systemically unstable patients from severe traumas, severe traumatic brain injury, and patients who died of their other injuries while being considered for surgical management of their facial fractures.…”

“…[4][5][6] Disrupted skeletal formation and growth disturbances caused by such craniofacial traumas have long-term consequences, as children who suffer from facial trauma/deformities are at higher risk for physical and psychological comorbidities. 7,8 Additionally, sportsrelated traumas are associated with traumatic brain injury (TBI), 7,9 and over one third of life-threatening injuries sustained by children are sports-related. 10 With up to 40% of children in the US playing sports regularly, 11 the growing popularity of sports has been paralleled by the increasing incidence of pediatric sports-related injury.…”

“…[12][13][14] Protective equipment, in some cases, has reduced the frequency of catastrophic injuries. 7,15 Despite the growing medical and economic implications of pediatric traumas, 16 particularly craniofacial traumas, existing literature suffers from small sample sizes 4,17 and/or outdated data. 18 Additionally, many pediatric trauma studies restrict inclusion criteria to patients under the age of 18; yet postpubertal physiologic development may continue well into early adulthood.…”

“…Despite ongoing prevention efforts and increased use of seatbelts, the number of patients presenting with both facial fractures and frontal sinus fractures continues to rise 7 . The purpose of the study was to evaluate our Level I Trauma Center University Hospital experience with frontal bone fractures through a case review to classify fracture types, review management methods, document associated injuries, and identify complications associated with various treatment options.…”

Delayed management of an orbital floor blow-out fracture

“…Delayed reconstruction leads to fibrosis, which could cause entrapped tissue to contract and restrict the globe motility (3). Even though surgically more challenging, late approach was still described as successful (6). Relative contraindications for surgery are hyphema, retinal tears, perforating globe injuries, or medical instability (7).…”