The ‘White-eyed’ Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

Saggese, Nicholas P.; Mohammadi, Ebrahim; Cardo, Vito A.

doi:10.7759/cureus.4412

Cited by 10 publications

(10 citation statements)

References 33 publications

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“…[11]. There is a general agreement that an acute loss of the visual function in the presence of a retrobulbar hematoma, severe enophthalmos, incarceration of peribulbar soft tissue and large defect sizes over 50% of the orbital floor require immediate surgical intervention to restore the anatomical structure of the orbit and improve the visual function as well as the orbital appearance [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions

Seifert

Mainka

Herrera-Vizcaíno

et al. 2021

Eur J Trauma Emerg Surg

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Objective The aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature. Study design One thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications. Results The average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm2 (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma. Conclusion Results of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm2.

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Section: Introductionmentioning

confidence: 99%

Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions

Seifert

Mainka

Herrera-Vizcaíno

et al. 2021

Eur J Trauma Emerg Surg

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“…Operations for our patients were conducted around 24 h after injury (Case 9: 6 h, Case 10: 26 h, Case 11: 7 h), leading to complete recovery. Even if the entrapment is unclear on CT scan images, TF with locked eye movement, oculocardiac reflex, or vomiting should be treated promptly with operation, especially in children [10,11].…”

Section: Discussionmentioning

confidence: 99%

Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

Narita

Ito

Kato

et al. 2021

JOHBM

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Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.

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“…Delayed or missed-out diagnosis of white-eyed blowout fracture can lead to extraocular muscle necrosis, permanent diplopia, blindness, restricted gaze, and life-threatening oculocardiac reflex complications. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

White-eyed blowout fracture

Prasad

Arulmozhi

Balaji

et al. 2020

Ann Maxillofac Surg

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White-eyed blowout fracture is often found in pure orbital floor blowout fracture among pediatric patients. Unlike common orbital blowout fractures with apparent clinical signs, the diagnosis of white-eyed orbital blowout fractures is difficult because of minimal soft-tissue signs. This report describes an early missed-out diagnosis of a white-eyed blowout fracture in a 7-year-old child, due to negligible soft-tissue manifestation.

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The ‘White-eyed’ Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

Cited by 10 publications

References 33 publications

Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions

Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions

Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

White-eyed blowout fracture

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