Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Yu, De-Yi; Chen, Chih‐Hao; Tsay, Pei-Kwei; Leow, Aik-Ming; Pan, Chun–Hao; Chen, Chien-Tzung

doi:10.1097/sap.0000000000000726

Cited by 27 publications

(36 citation statements)

References 30 publications

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“…Incarcerated orbital tissues frequently cause limited ocular motility and subsequent diplopia [ 5 , 6 ], and in pediatric patients, these symptoms can be persistent even after relevant surgery [ 6 , 7 ]. There had been studies reporting factors affecting surgical outcomes in adult orbital wall fracture patients [ 8 ]. Yu et al[ 8 ] reported higher number of fractures and delayed surgical timing as poor prognostic factors of orbital wall fracture.…”

Section: Introductionmentioning

confidence: 99%

Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation

et al. 2017

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ObjectivesTo investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.DesignRetrospective observational case series.MethodsIn this retrospective observational case series, 150 pediatric patients (1–18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed.ResultsOf the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19–2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07–1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54–8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45–9.82) were found as negative prognostic factors for the recovery of motility limitation.ConclusionsPresence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.

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Section: Introductionmentioning

confidence: 99%

Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation

et al. 2017

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“…Several algorithmic guidelines have been proposed combining both radiographic and examination findings to determine a patient's candidacy for surgical management. 1,4,32,40,45,[56][57][58][59] However, no study to date has prospectively evaluated specific indications for early post-injury repair of the orbital floor. Most retrospective studies are limited as different time intervals until surgical intervention are not specified.…”

Section: Discussionmentioning

confidence: 99%

Does Early Repair of Orbital Fractures Result in Superior Patient Outcomes? A Systematic Review and Meta-Analysis

Jazayeri

Khavanin

Dorafshar

2020

Journal of Oral and Maxillofacial Surgery

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“…We disagree with the suggestion that a BOF with diplopia, not due to ocular motility limitation, requires surgical intervention within 2 weeks. 22 Hypoesthesia of the infraorbital nerve remains both in the observational and the surgical groups and may persist after 1 year. However, we found that surgery could induce hypoesthesia which therefore should be a part of patient informed consent.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

Alinasab

Borstedt

Rudström

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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To clarify the conflicting recommendations for care of blowout fracture (BOF), a prospective randomized study is required. Here, we present a prospective randomized pilot study on BOF. This article aimed to evaluate which computed tomography (CT) findings predict late functional and/or cosmetic symptoms in BOF patients with ≥ 1.0 mL herniation of orbital content into maxillary and/or ethmoidal sinuses. It also aimed to evaluate which patients with BOF would benefit from surgical treatment or observational follow-up. Twenty-six patients with BOF ≥ 1.0 mL herniation were randomized to observational ( = 10) or surgical treatments ( = 16) and were followed up for functional and cosmetic symptoms for at least 1 year. The results from CT scan measurements were correlated to the patients' symptoms and clinical findings which we report in this pilot study. Of the 10 patients randomized to observation, five had an inferomedial BOF with a herniation of ≥ 1.3 mL and all patients developed cosmetic deformities and required surgery. The remaining five patients in the observational group had inferior BOF and one of them had a distance of 3.3 cm from the inferior orbital rim to the posterior edge of the fracture and developed a cosmetic deformity but was unwilling to proceed to surgical treatment, and four patients had a median distance of 2.9 cm from the inferior orbital rim to the posterior edge of the fracture and did not develop cosmetic deformities. The median time from injury to surgery was 13 (3-17) days for the surgical group and 37 (17-170) days for the patients who underwent surgery in the observational group. The surgical results were similar for all the operated patients at the final control. Diplopia decreased and remained partly in one patient in the surgical group and in two patients in the observational group. Hypoesthesia of the infraorbital nerve decreased in nonsurgically treated patients, but surgery seemed to induce hypoesthesia. In this prospective randomized controlled pilot study on BOF, all patients in the observational group with inferomedial fractures developed visible deformity. Diplopia in BOF, without ocular motility limitation, is believed to be due to edema. Diplopia is not an indication for surgery as long as it reduces over time.

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Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Cited by 27 publications

References 30 publications

Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation

Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation

Does Early Repair of Orbital Fractures Result in Superior Patient Outcomes? A Systematic Review and Meta-Analysis

Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

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