Neurosensory recovery after trauma to the orbital floor: a prospective trial with dexamethasone

Abstract

Our aims were to document the occurrence of neurosensory disturbances of the infraorbital nerve six months after operation for an orbital blow-out fracture, and to find out whether dexamethasone facilitates neurosensory regeneration. Patients were randomly assigned to one of two groups: the study group was given a total of dexamethasone 30mg, whereas the control group were given neither glucocorticoid nor placebo. Each patient's infraorbital neurosensory state was recorded preoperatively, immediately postoperatively, and six months later. A total of 18 patients were included, eight of whom had neurosensory disturbances six months after the initial trauma that was not affected by dexamethasone. Six of the seven patients who had a delay of seven days or more between trauma and operation had significantly prolonged disturbance at the 180-day clinical follow up compared with those in whom it was less than seven days (p=0.005). Other possible predictors made no significant difference. Although dexamethasone did not facilitate sensory recovery, its benefits in the management of pain and reduction of swelling may justify its use in the management of facial trauma in selected patients.

Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures

“…Evidence-Based Medicine: Trials have demonstrated a negligible effect of perioperative steroids on postoperative nausea and vomiting 25 ( Level of Evidence: I ), infraorbital sensory recovery 26 ( Level of Evidence: II ), and wound healing 27 ( Level of Evidence: III ), but have demonstrated a significant reduction in edema following orbital exploration 28 ( Level of Evidence: II ). However, literature evaluating the effect of steroids on infection rates is lacking.…”

Complications and complaints in craniofacial fractures – Finnish national data for 20 years

“…The complications reported in the literature, for example, in orbital blow-out fractures have been diplopia, infraorbital nerve injury, and esthetics which are fortunately often transient but affect the quality of life severely [21]. One of the factors proven to diminish long-lasting neurosensory disturbance has been short delay (<1 week) to surgical intervention when surgery is clinically indicated [22]. Indeed, the current study revealed that a delay-related cause was by far the most common cause of malpractice complaint (63.2%), compared with other causes.…”

Wilderness Medical Society Clinical Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2024 Update

“…Patients may find relief from congestion through the use of nasal decongestant sprays, and if systemic steroids are available, they may be used to decrease orbital edema. 39,40 Beyond this basic medical management, emergent evacuation is recommended if signs of ocular muscle entrapment, traumatic vision loss, or suspected globe rupture are present.…”