Surgical Timing in Orbital Fracture Treatment: Experience with 108 Consecutive Cases

Abstract

Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.

Morphological and functional changes of the optic nerve following traumatic optic nerve injuries in rabbits

“…These results indicate that following optic nerve injury, early decompression can protect the visual function better than later decompression, and to a certain extent it can reverse the damage on visual function, as early decompression (1 week) can prevent axon secondary injury, avoiding further visual function decline, whereas decompression 2 weeks after is not ineffective. From 108 cases of clinical superciliary arch fractures, Matteini et al (1) concluded that the best surgical intervention must be carried out within 7 days, and <12 days, which is consistent with the present experimental results.…”

“…Optic nerve sheath membrane hemorrhage due to the fracture of the skull base can cause subdural or subarachnoid hemorrhage, and optic nerve avulsion can be caused by orbital trauma. All these can cause traumatic optic nerve injury (1). Visual evoked potential examination has an extremely important value for the diagnosis of traumatic optic neuropathy.…”

The predictive factors of diplopia and extraocular movement limitations in isolated pure blow-out fracture

“…Many studies evaluated the factors influencing the incidence rate of diplopia and EOM limitations in blow-out fracture cases with different inclusion criteria and different results 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. For example, Parks and colleagues evaluated the relationship between type of fracture and postoperative diplopia and found that diplopia was more commonly observed in inferior and inferomedial wall fractures 1 .…”

Orbital fractures in the emergency department: a review of early assessment and management

“…At present, consensus remains that in most cases, delayed treatment of orbital fractures is ideal practice 40. Exceptions to this rule include: persistent oculocardiac reflex with bradycardia, heart block, nausea and vomiting; and ‘white-eye’ blowout fractures with entrapment in children and adolescents.…”