The better surgical timing and approach for orbital fracture: a systematic review and meta-analysis

Abstract

Background: A large number of empirical studies on the surgical timing and approach of orbital fracture have been published, but which surgical timing and approach is better is still a dispute. We use a systematic review and meta-analysis to solve this problem.Methods: We performed a systematic search in the databases of PubMed, Cochrane Clinical Trials Database, Embase, and Web of Science for relevant literature. The search terms included those concerning or describing orbital fracture, timing, and approach, which are based on population, intervention, control, outcome, and study (PICOS) framework. The statistical software packages RevMan 5.4 and Stata 14.0 were used for data analysis. We sought to evaluate postoperative complications, and results were expressed as odds ratio (OR) with 95% confidence interval (CI). Forest plots, sensitivity analysis, funnel plots, Egger's test, and risk bias analysis were also performed on the included articles by using the Newcastle-Ottawa scale (NOS).Results: A total of 7 trials involving 1,283 patients compared the surgical timing of ≤14 days versus >14 days, and another 14 trials involving 1,768 patients compared the surgical strategy of transconjunctival approach (TCA) with that of subciliary approach (SCA) for orbital fracture. The quality of all articles was higher than 7 points, which means all articles were at low risk of bias. Surgery conducted within 14 days significantly reduced the incidence of diplopia (OR: 0.53, 95% CI: 0.34 to 0.83, P=0.005) and enophthalmos

Considering the Interaction between Surgical Approach and Timing on Complication Rates of Complex Orbital Fracture Repair

“…A lower complication rate with surgery of less than 14 days has been cited in the literature. 1,[5][6][7] Operative delay can be associated with poor outcomes, with some studies demonstrating a higher rate of entropy, enophthalmos, and diplopia when a cutoff time of 14 days was used. Early intervention can reduce periorbital soft tissue scarring, tissue compression, stretching, and soft tissue displacement due to massive periorbital edema.…”

“…Early intervention can reduce periorbital soft tissue scarring, tissue compression, stretching, and soft tissue displacement due to massive periorbital edema. 1,5,8,9 The surgical approach that can lead to the greatest fracture exposure while limiting iatrogenic injury should be chosen at an earlier time point if surgery is indicated.…”

“…The earlier average time to surgery in this series of 11.7 days was effective in limiting postoperative complications. A lower complication rate with surgery of less than 14 days has been cited in the literature 1,5–7 . Operative delay can be associated with poor outcomes, with some studies demonstrating a higher rate of entropy, enophthalmos, and diplopia when a cutoff time of 14 days was used.…”

“…Operative delay can be associated with poor outcomes, with some studies demonstrating a higher rate of entropy, enophthalmos, and diplopia when a cutoff time of 14 days was used. Early intervention can reduce periorbital soft tissue scarring, tissue compression, stretching, and soft tissue displacement due to massive periorbital edema 1,5,8,9 . The surgical approach that can lead to the greatest fracture exposure while limiting iatrogenic injury should be chosen at an earlier time point if surgery is indicated.…”

“…Surgical repair of complex orbital fractures can be complicated by postoperative lid malposition, gaze restriction, and diplopia. [1][2][3] Surgeons work to minimize postoperative complications and restore the periorbital form and function by choosing the optimal surgical approach for fracture repair and the appropriate timing of repair.…”