Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP. Patients and methods A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference. Results A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm 2 ) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP). Conclusion GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

Correlação entre o aumento do volume orbitário pós trauma em face e as repercussões clínicas

“…Devido a complexa anatomia da região e ao frequente acometimento do globo ocular, fraturas de paredes da órbita, podem apresentar diversas complicações, com alta morbidade, dentre as quais destaca-se a redução do nível de consciência do paciente (Felding et al, 2016; As fraturas de órbita podem apresentar padrões isolados ou envolver outras estruturas ósseas e de tecido mole, como por exemplo, as fraturas do complexo zigomático-maxilar e as fraturas naso-órbito-etmoidais (Rajkumar et al, 2015;Hartwig et al, 2019). A correlação entre o aumento do volume da órbita, verificado por meio de exames complementares, e o desenvolvimento de alterações clínicas tem sido frequentemente discutida na literatura atual (Schönegg et al, 2018;Snäll et al, 2019). Alhamdani et al (2015) descrevem as principais injúrias oftalmológicas após trauma em face cursando com fraturas em parede de órbita, são elas: hifema, midríase traumática, abrasão da córnea e equimose conjuntival.…”

Three-Dimensional Computer-Aided Analysis of 293 Isolated Blowout Fractures – Which Radiological Findings Guide Treatment Decision?

“…However, Young et al 25 reported a mean residual enophthalmos of 2.1 mm to be clinically irrelevant, and it seems like most non-surgically treated patients don't have aesthetically disfiguring enophtalmos after 12month follow-up 26 . Additionally, enophthalmos can persist even after successful surgery 27 . This makes it extremely difficult to evaluate the need for surgical intervention solely based on radiological findings.…”

Management of Posttraumatic Enophthalmos Including Complex Secondary Deficits

“…However, in patients who display postoperative PE, overcorrection of orbital volume can also result in GMP with as little as 1.15 ml of volume correction. 15…”