Orbital Floor Fractures: Evaluation, Indications, Approach, and Pearls from an Ophthalmologist's Perspective

Lelli, Gary Joseph; Milite, James; Maher, Elizabeth A.

doi:10.1055/s-2007-984559

Cited by 40 publications

(30 citation statements)

References 17 publications

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“…Numerous studies have been performed on orbital fractures so far [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. However, much of the literature is either out of date or based on small groups of patients.…”

Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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Purpose: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist’s perspective. Methods: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. Results: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the ‘comminuted’ one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (≧2 mm) patient population was improved from 2.62 (±SD 0.9) to 1.73 (±SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. Conclusion: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

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Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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“…In the treatment of blowout fractures with muscle entrapment, early exploration and release of entrapped muscle has been recommended by many authors [7][8][9]. The rationale of early intervention has been the supposed increased likelihood of ischaemic necrosis, fibrosis, and scarring of entrapped muscles [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…However, from the late 1970s, thanks to development in the analysis of anatomical structures of orbital connective tissue [2,3], and advances in the ability to diagnose different fracture types (punched-out or linear type) using computed tomography (CT) [4,5], the discussion on surgical indications for blowout fracture is gradually reaching its conclusion [6]. Many authors have advocated early intervention to avoid muscle degeneration in patients for whom there is CT evidence of extraocular muscle entrapment [7][8][9]. Although delay in management may result in permanent dysfunction of the extraocular muscles, there is still no golden standard with regard to the timing of operations to release entrapped muscle.…”

Section: Introductionmentioning

confidence: 99%

Timing of operation for blowout fractures with extraocular muscle entrapment

Sugamata¹,

Yoshizawa²,

Shimanaka³

2013

Journal of Plastic Surgery and Hand Surgery

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Many authors have advocated early surgical intervention to avoid muscle degeneration in patients with blowout fractures with evidence of extraocular muscle entrapment imaged under computed tomography. However, there is still no golden standard with regard to the target timing of operations for releasing extraocular muscle. Between January 2002 and December 2011, the authors treated eight cases of blowout fracture with extraocular muscle entrapment. Notes from presumed cases of blowout fracture were retrospectively reviewed for information relating to surgical treatment and prognosis. In this series, a patient who was operated on 7 hours after injury showed the quickest recovery from diplopia. In contrast, a patient who was operated on 18 days after injury showed persistent diplopia for 2 years. Nevertheless, in patients who were operated on 3-11 days after injury, there was no obvious correlation between the outcome and the number of days between injury and the operation. It is concluded that, when emergency surgical intervention within several hours is not possible, it should be performed as soon after the injury as possible in order to prevent the increase of predictive fibrosis around the extraocular muscle.

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“…No consensus exists on the choice of implants for orbital floor reconstruction. The literature mentions different materials (1,3,4,6,7,8,10,13) such as autogenous (bone, periosteum, fascia, cartilage), heterologous (lyophilized dura mater, pericardium, bovine collagenous fibres, lyophilized cartilage), or resorbable (Ethisorb, gelfilm, polylactic and polyglycolic acid plates and screws) and nonresorbable synthetic materials (teflon, silicone, silastic, collagen, titanium mesh).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of an Orbital Floor Fracture in a 4-Year-Old Child

Chrobok

Pellant

Novák

et al. 2008

Acta Med. (Hradec Kralove, Czech Repub.)

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The most frequent orbital wall fractures involve the orbital floor. Such fractures can be divided into transmarginal and retromarginal (blowout) fractures. Two theories of retromarginal fracture aetiology have been described: the hydraulic theory and the bone conduction mechanism.The former refers to a direct force to the globe and its compression (blowout), which increases intraorbital pressure and leads to a fracture of the weakest point of the orbital bone (the orbital floor or the medial orbital wall). The latter suggests a force to the lower orbital rim, which transfers pressure to the orbital floor and results in its fracture (9).A conservative or a surgical therapeutic approach should be selected according to the extent and localization of the injury and according to the difficulties exhibited by the patients. In addition, retromarginal fractures of the orbital floor in children are unique due to the pathology involved in the orbital bone injury and due to a distinctive surgical approach.The report presents a fracture of the orbital floor in a child. Furthermore, therapeutical options in retromarginal fractures of the orbital floor are discussed. Case ReportA 4-year-old girl was running in a garden and hit her face against an agricultural machine. Subsequently, she started to bleed from her nose, and a haematoma of her left lower eyelid and her left cheek developed. She did not have any period of unconsciousness. A CT examination of the orbits and the paranasal sinuses in the coronal plane revealed a retromarginal fracture of the orbital floor with large soft tissue herniation into the maxillary antrum ( Fig. 1) with no ocular muscle restriction. A consulting ophthalmologist did not find any visual acuity impairment. Furthermore, movements of the eyeballs were not restricted, and the child did not report diplopia. Oedema subsided on the 6th day after the injury, and surgery was performed. The indication for surgery was a large soft tissue herniation in the maxillary sinus. Bone fragments of the orbital floor and a tear of the perforated orbital periosteum were found after performing a transconjuctival incision combined with a lateral canthotomy. After lifting the soft orbital tissues and the orbital periosteum from the maxillary antrum, a partly absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum to provide support. A forced duction test prior to and after the reduction proved an absence of extraocular muscle restriction. Next, the incision was sutured. After the surgery the child made an uneventful recovery, her visual acuity was not impaired, her eyeball movements were not restricted, and diplopia was not present. A follow-up MRI examination of the orbits and the paranasal sinuses one month after the surgery demonstrated the collagenous mesh and the orbital soft tissues in a good position without any signs of dislocation into the maxillary antrum (Fig. 2). DiscussionThe region medial to the infraorbital neurovascular bundle, approximately 10 mm posterior to...

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Orbital Floor Fractures: Evaluation, Indications, Approach, and Pearls from an Ophthalmologist's Perspective

Cited by 40 publications

References 17 publications

An Analysis of 733 Surgically Treated Blowout Fractures

An Analysis of 733 Surgically Treated Blowout Fractures

Timing of operation for blowout fractures with extraocular muscle entrapment

Reconstruction of an Orbital Floor Fracture in a 4-Year-Old Child

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