Classification and Surgical Management of Orbital Fractures: Experience With 111 Orbital Reconstructions

Abstract

Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.

Computer‐assisted therapy in orbital and mid‐facial reconstructions

“…A principle goal of therapy is to anatomically reduce fracture segments and to restore a normal orbital volume as soon as possible (1,2). The most common complication associated with incorrect reconstruction of orbital dimensions is enophthalmos; as a consequence, disturbance of eye motility together with double images is likely to occur (2,3). Diagnostic advances such as new surgical and imaging techniques have dramatically improved both the functional and aesthetic outcome of reconstructions (4,5).…”

Profile of Trauma-related Residual Periorbital Deformities in Indian Children

“…The causes of reduced visual acuity were mainly corneal scarring, amblyopia and macular scar as was also observed in a previous study [3]. In two different studies the associated ocular injuries in patients with orbital trauma was 33 and 53% respectively [7,8]. In contrast to this, in a study on open globe injuries, associated orbital and adnexal injuries were present in 24.7%, with eyelid laceration and orbital fracture as common injuries.…”

“…However, relatively little information is available on it in the literature, especially from the developing countries. Most of the studies available are in the general population [1][2][3][4], or limited to specific types of injuries or circumstances [5][6][7][8][9]. By determining patient demographics, causes of the facial injuries, extent of periorbital damage and the circumstances under which they were incurred, we hope to identify predisposing factors.…”

Craniofacial Fracture Symptoms

“…A loss of vision in midface fractures occurs in 15-20% of all severe midface injuries (Jabaley 1975;Holt and Holt 1983;Al-Qurainy IA et al 1991 a, b, c;Dutton and Al-Qurainy 1991;Brown et al 1999;Poon et al 1999;Cook 2002;Manolidis et al 2002;Soparkar 2005). Injury to the optic nerve most frequently occurs in central fronto-naso-ethmoidal fractures due to fractures along the lesser wing of the sphenoid and seldomly in complex lateral midface fractures with fractures of the greater wing of the sphenoid (Ketchum et al 1976;Kretschmer 1978;Hardt and Steinhaeuser 1979;Chilla 1981;Bleeker and Los 1982;Lipkin et al 1987;Fonseca and Walker 1991;Vitte et al 1993;Lädrach et al 1999;Soparkar 2005;Stewart 2005).…”

“…In order of frequency, orbital wall fractures occur particularly in combination with the following fracture complexes (Paskert et al 1988;Fonseca and Walker 1991;Manson 1998;Manolidis et al 2002):…”