Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases

Abstract

Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0–361.0) and a median postoperative hospital stay of three days (0–25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.

Clinical Significance of Diplopia and the Orthoptic Examination in Zygomatic Maxillary Complex Fractures

“…Literature analysis showed a large diversity of results regarding the incidence of diplopia and the clinical importance given to it, nonetheless, its validation is shown by its inclusion in several facial trauma scores, often used as a major index. 7,[9][10][11] The results show an overall symptom occurrence slightly higher than literature reports. Specifically, 15.6% of patients showed diplopia at the clinical examination, whereas 21.9% showed diplopia at the orthoptic evaluation.…”

“…Literature analysis showed a large diversity of results regarding the incidence of diplopia and the clinical importance given to it, nonetheless, its validation is shown by its inclusion in several facial trauma scores, often used as a major index 7,9–11 …”

“…2 Literature describes conflicting rates of diplopia associated with zygomatic maxillary complex (ZMC) fractures, spanning from 6% to 40%, oftentimes with little information on the diagnostic methods used. [3][4][5][6][7] Such a wide range of reports led us to critically compare the literature data with our experience. The aim of this study was to retrospectively assess the prevalence of diplopia in ZMC fracture patients, the usefulness of the orthoptic evaluation compared to the clinical finger-tracking examination, and to seek possible relations of this symptom with clinical parameters.…”

“…Literature describes conflicting rates of diplopia associated with zygomatic maxillary complex (ZMC) fractures, spanning from 6% to 40%, oftentimes with little information on the diagnostic methods used 3–7 . Such a wide range of reports led us to critically compare the literature data with our experience.…”