Surgical Treatment of Orbital Floor Fractures

Abstract

\s=b\This study retrospectively examines 551 patients with 597 orbital floor fractures for sequelae of enophthalmos and diplopia. Ocular injuries are associated with 6.9% of the fractures. Nondisplaced orbital floor fractures have been treated with observation alone, resulting in an incidence of sequelae of zero in 263 patients. Displaced fractures that had not undergone surgery have resulted in an incidence of sequelae of 18 (34%) in 53 patients. Displaced fractures that had undergone orbital floor exploration have resulted in an incidence of sequelae of 29 (10.3%) in 281 patients. Only one mild loss of visual acuity has complicated the 281 surgical procedures. It is concluded that orbital floor exploration is not indicated in patients with nondisplaced fractures of the orbital floor and that orbital floor exploration is a safe and effective means of reducing the complications associated with displaced fractures of the orbital floor. (Arch Otolaryngol 1982;108:184-186) Fractures of the orbital floor may occur as isolated injuries or as a component of midface facial frac¬ tures. Before 1940, orbital floor frac¬ tures were not regularly addressed in the literature that described treat¬ ment of maxillofacial trauma. Conse¬ quently, treatment was inadequate, and enophthalmos and diplopia were relatively common sequelae. As a result of the work of Converse and Smith1 in 1950, awareness of this problem increased, and surgeons became aggressive in its therapy. Exploration of orbital floor fractures became routine, and complications occurred, eg, ectropion and loss of visual acuity, leading many clinicians to condemn this routine exploration.Controversy has subsequently aris¬ en as to the proper approach to orbital floor fractures. At one end of the spectrum, early exploration of orbital floor fractures is advocated (ie, within seven to ten days) in all cases before irreversible scarring and loss of peri-

Analysis of Orbital Bone Fractures

“…These findings were consistent with those reported by Shere et al, 5 Converse et al, 10 and Koutroupas and Meyerhoff. 12 Head and neck injuries were the most common isolated injuries associated with orbital bone fractures and included brain injuries with cranial blood vessel disruption and altered levels of consciousness, cervical spine injuries, and optic nerve injuries. The most common soft-tissue injury associated with orbital bone fractures was injury of the head and neck.…”

Delayed Treatment of Zygomatic Tetrapod Fracture

“…In particular, the zygomatic bone is an anatomical structure that determines the outer shape of the mid face. If zygomatic fracture is associated with orbital wall fracture, it must first be corrected according to the guidelines for orbital wall fracture correction (7, 8). In our case, we made a temporal incision in order to obtain the wide surgical visual field for refracturing the fused zygomatic arch.…”