A Current 10-Year Retrospective Survey of 199 Surgically Treated Orbital Floor Fractures in a Nonurban Tertiary Care Center

Abstract

This study characterizes the surgically treated patient population suffering from orbital floor fractures by use of current data from a large series consisting of 199 cases taken from a nonurban setting. Data were gathered through a retrospective chart review of patients surgically treated for orbital floor fractures at the University of Michigan Health System, collected over a 10-year period. Data regarding patient demographics, signs and symptoms of presentation, cause of injury, nature of injury, associated facial fractures, ocular injury, and associated nonfacial skeleton trauma were collected. In total, there were 199 cases of orbital floor fractures among 189 patients. Male patients outnumbered female patients by a 2:1 ratio and were found to engage in a wider range of behaviors that resulted in orbital floor fractures. Motor vehicle accidents were the leading cause of orbital floor fractures, followed by physical assault and sports-related mechanisms. The ratio of impure to pure orbital floor fracture was 3:1. The most common signs and symptoms associated with orbital floor fractures, in descending order, were periorbital ecchymosis, diplopia, subconjunctival hemorrhage, and enophthalmos. Associated facial fractures were found in 77.2 percent of patients, the most prevalent of which was the zygoma-malar fracture. Serious ocular injury occurred in 19.6 percent of patients, with globe rupture being the most prevalent, accounting for 40.5 percent of those injuries. There was a 38.1 percent occurrence of associated nonfacial skeletal trauma; skull fracture and intracranial injury were the most prevalent manifestations. Associated cervical-spine fractures were rare (0.5 percent). Statistical examination, using odds ratios and chi-squared analysis, demonstrated significant associations that have not previously been reported. Impure and pure orbital floor fractures revealed striking differences in several demographic aspects, including mechanism of injury, signs and symptoms of presentation, spectrum of associated trauma, and the severity of concomitant trauma.

Etiologia e incidência das fraturas faciais em adultos e crianças: experiência em 513 casos

“…In this situation the fracture may be difficult to see due to overlapping of anatomical structures (orbit wall and temporal bone) 12,23 . According to Busuito et al (1986) and Sherer et al (1989) these failures in diagnosis do not occur with other facial fractures (mandibular and maxillary fractures), mostly caused by motor vehicle accidents and physical violence.…”

“…Other options such as correction with the patient awake, therefore feeling pain and unable to cooperate adequately, induce failure and may require a second or third surgical procedure 11,12,18 . In our experience we have seen a large number of pyramid and nasal septum deviation due to previous trauma treated conservatively or with inadequate surgical correction in hospital emergency wards.…”

“…Facial trauma has a heterogeneous etiology and the predominance of one or another factor is due to characteristics of the population under study (age, gender, social status, urban and residential sites) [9][10][11][12] . In certain regions of our country and in parts of Europe bicycles are widely used for leisure or transport, increasing the possibility of accidents with this vehicle.…”

An Analysis of 733 Surgically Treated Blowout Fractures

“…It can be associated with various ocular and extraocular injuries, and failure of prompt recognition and treatment of these injuries may result in significant cosmetic and functional problems, such as enophthalmos, restriction in ocular motility and ocular dystopia [3]. …”

Traumatismos Maxilofaciais em Crianças e Adolescentes em Campina Grande, Paraíba, Brasil

“…Trata-se de um trauma de abrangência multidisciplinar, envolvendo principalmente as especialidades de cirurgia geral, oftalmologia, cirurgia plástica, bucomaxilofacial e neurocirurgia 6 . A etiologia dos traumatismos faciais é heterogênea e o predomínio maior ou menor de um fator etiológico se relaciona com algumas características da população estudada: idade, gênero, classificação social 7 . Em crianças e idosos, as fraturas faciais estão associadas a quedas dentro de casa ou a jogos e brincadeiras infantis.…”