The Role of Postoperative Imaging after Orbital Floor Fracture Repair

Abstract

Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role of postoperative imaging in the management of orbital floor fractures in isolation and with concomitant facial fractures. Retrospective review of patients who underwent open reduction and internal fixation of orbital floor fractures between 2005 and 2015 at a single medical institution. Operative and perioperative records were reviewed to characterize postoperative imaging as routine or as indicated by concerning clinical symptoms, and to correlate clinical outcomes to postoperative imaging patterns across all identified orbital floor fractures. A total of 139 patients underwent open reduction and internal fixation of orbital floor fractures. Of these, 75 (54%) had zygomaticomaxillary (ZMC) involvement. The remaining 64 (46%) were isolated orbital floor fractures. Overall, 54 (39%) patients underwent postoperative imaging. Of these, 38 (70%) had postoperative imaging in the absence of concerning clinical symptoms. There was no observed difference in complication rates in those who underwent postoperative imaging, and those who did not. Patients with orbital + ZMC fractures underwent a significantly higher number of postoperative imaging studies ( < 0.001); however, there was no observed difference in complications between isolated orbital and orbital + ZMC fractures. Routine postoperative imaging is not warranted in the absence of persistent clinical symptoms following open reduction and internal fixation of orbital floor fractures.

Surgical Management of Orbital Fractures Using X-ray Film Plate: a Retrospective Case Series

“…19 Moreover, it has also been shown that postoperative imaging in the absence of persistent clinical symptoms has no additional benefit in determining the complication rate. 20 Consequently, we did not obtain postoperative images of the participants in our study.…”

Globe Fixation Caused by Intraocular Migration of an Orbital Floor Implant

“…Nevertheless, this practice is proven to be not cost-effective and is therefore not recommended in asymptomatic patients after orbital floor repair due to the rarity of this complication. 4 The manufacturer of this specific implant does, however, recommend postoperative imaging to check correct positioning. 5 We want to highlight the importance of correct positioning of orbital reconstructive material and of thorough evaluation of obtained imaging in case of postoperative complications, such as restrictive strabismus.…”

Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence

“…CT-DCG has the advantage of providing both the bony anatomic details and the level of obstruction in the lacrimal drainage system and is extremely helpful in managing such cases. [ 7 ] In addition, three-dimensional reconstructed images provide more information about the location of the previously placed mini plates and screws, titanium mesh, or silastic sheets. This, in turn, helps in preoperative planning and intraoperative decision-making.…”

“…None of the patients in this series were advised a postoperative CT scan by the primary surgeon, though it is always advisable in symptomatic patients. [ 7 ]…”

“…We recommend postoperative scans in all patients undergoing fracture repair. [ 7 ] CT-DCG is an important diagnostic tool and should be requested whenever patients present with complaints of epiphora and discharge in the postoperative period. It can help localize the level of the obstruction and also point out the exact cause of the obstruction in cases of INDO.…”