Orbital Fractures Complicated by Late Enophthalmos: Higher Prevalence in Patients With Multiple Trauma

Abstract

The findings of more walls affected and higher incidence of zygomatic fractures in MT patients probably represent a stronger impact of the original insult, causing both more damage to other organs and more severe damage to the orbit. The increased rate of late enophthalmos in MT patients may be associated with their primary presentation to the emergency room with potentially life-threatening injuries. Under such circumstances, thorough ophthalmologic examination is nearly impossible, both because the patient cannot cooperate sufficiently and because medical priorities dictate concentration on taking care of the injuries threatening life. The lack of a thorough ophthalmic examination prevents early comprehensive treatment.

Pearls of Orbital Trauma Management

“…The likelihood of imperfect orbital reconstruction is significantly increased in patients with concomitant areas of trauma and who have more than one orbital wall affected. 4 If malpositioned, correction is performed by re-placing the implant into anatomic position. With late-presenting enophthalmos related to fat atrophy, orbital volume can be re-established with onlay alloplastic or autogenous bone grafts.…”

“…MVA-related orbital fractures, in particular, tend to be more destructive and are associated with more concomitant organ injuries, zygoma fractures, and multiple orbital wall fractures than the other common causes of assault, sports-related, falls, and so forth. 4 Penetrating orbital injuries occur less frequently but are associated with a greater than 10% incidence of death or subsequent vegetative state, mostly due to adjacent intracranial injuries. 5 Additionally, damage to the globe, optic nerve, and extraocular muscles are always a concern.…”

Reconstruction of Acquired Orbital Deformity Characterized by Volume Change

“…In patients with facial trauma, the diagnosis of orbital wall fracture is likely to be missed and the opportunity of early treatment lost. 2 It is most likely a consequence of financial limitations of the patient or the neglect of the physicians, so that orbital computed tomographic (CT) scan is not performed. The simple x-ray is inappropriate for comprehensive evaluation for orbital deformity, and CT scan is more helpful in the diagnosis.…”

Multidetector CT of Midfacial Fractures: Classification Systems, Principles of Reduction, and Common Complications

“…From 10% to 30% of facial fractures involve the orbit (41,42). Orbital fractures are not clinically obvious in unconscious patients with facial swelling (43); and diagnosis, prognostication, and treatment planning rely heavily on the findings at CT (41,42). Orbital fractures can be pure, defined as those limited to the internal orbit, or impure, defined at those with orbital rim involvement requiring realignment before reconstruction of the internal orbit (41).…”