Is Delayed Release of Superior Oblique Muscle Entrapment in Orbital Roof Fracture Worth Correcting?

Background: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. Methods: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. Results: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. Conclusions: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures

Gebran

Lopez

Wasicek

et al. 2020

Plastic &Amp; Reconstructive Surgery

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A case of isolated blowout fracture of the orbital roof, trapdoor type, repaired using the transpalpebral approach

Onda

2022

Showa Univ J Med Sci

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Is Delayed Release of Superior Oblique Muscle Entrapment in Orbital Roof Fracture Worth Correcting?

Cited by 2 publications

References 6 publications

Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures

Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures

A case of isolated blowout fracture of the orbital roof, trapdoor type, repaired using the transpalpebral approach

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