Predictors of enophthalmos among adult patients with pure orbital blowout fractures

Abstract

The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher’s exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17–7.92).Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated.

The Orbital Index: a novel comprehensive quantitative tool for prediction of delayed enophthalmos in orbital floor fracture management

“…We found that patients with Orbital Index scores of 4 or greater were statistically more likely to undergo operative management and, if not operated on, to develop enophthalmos. Although these findings support the notion that a majority of facial trauma teams are operating appropriately, there remains a significant cohort of “false-negative” patients with large posteromedial fractures disrupting the fascioligamentous sling who are not offered surgery, and they are at high risk for developing enophthalmos 3,5–8,13 ; indeed, approximately half our study cohort of unoperated patients had Orbital Index scores of 4 or greater. By delineating better predictive guidelines, we hope to ameliorate this diagnostic gap.…”

A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

“…Pure orbital blowout fractures, also known as internal orbital floor fractures, occur within the confines of the internal orbital wall and do not affect the orbital rim or other facial bones. These fractures are common in individuals who experience blunt trauma to the facial and skull region [1][2][3]. The treatment of orbital blowout fractures is challenging mainly due to the restricted intraoperative view of the intricate and delicate anatomical region.…”

Analysis of Orbital Blowout Fracture Location and Hess Area Ratio

“…There are multiple reports proposing that enophthalmos is caused by the expansion of orbital volume 1–6 . Sung et al 4 reported that there is a significant linear positive correlation between the area of the medial orbital wall fracture and the degree of enophthalmos.…”

“…Moreover, several studies have focused on the relationship between fracture location and enophthalmos. Ahmad Nasir et al 5 described that the involvement of the posterior ledge and inferior orbital fissure is significantly associated with enophthalmos. A report by Alinasab et al 6 on patients with hernia suggested that a visible deformity is related to the distance from the inferior orbital rim to the posterior edge of the fracture.…”