Orbital blowout fracture location in Japanese and Chinese patients

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

Assessment of the Correlation Between Types of Orbital Fractures and Ocular Symptoms, and the Effect of Manual Preformed and Patient-Specific Mesh Implants: A Retrospective Study

OBJECTIVE

Although certain orbital fractures are associated with specific clinical symptoms, these relationships should be reviewed comprehensively. The optimal choice between manual preformed mesh implants (MPIs) and patient-specific mesh implants (PSIs) for orbital reconstruction remains undetermined due to inconclusive evidence regarding their effectiveness.

METHODS

This retrospective study investigated 280 patients with unilateral orbital fractures to explore the correlation between clinical ocular symptoms, including diplopia, enophthalmos, limitation of ocular movement, blindness, and the specific type of orbital fracture. The effects on orbital volume (OV) and orbital volume ratio (OVR) of MPI and PSI with and without the use of navigation were also evaluated in this study. Patients were categorized into 4 groups: MPI, PSI, navigation-assisted MPI, and navigation-assisted PSI. After this categorization, alterations in OV and OVR were analyzed before and after surgical intervention.

RESULTS

Significant correlations were observed between the orbital fracture type and diplopia, enophthalmos, and limitation of ocular movement (P < 0.05). Patients in the MPI group exhibited a notable difference in the postoperative OV between the injured and normal sides (P < 0.05), but no statistically significant difference was found in the postoperative OV between the injured and normal sides among the patients in the other 3 groups (P > 0.05). Moreover, the MPI group demonstrated significantly higher postoperative OVR than the other groups (P < 0.05). Notably, PSI remained effective with or without navigation, MPI combined with navigation technology achieved a reconstruction quality similar to that of PSI by rectifying positioning errors during surgery.

CONCLUSION

The authors found significant correlations (P < 0.05) between orbital fracture type and diplopia, enophthalmos, and limitations of ocular movement. Patient-specific mesh implant plays an important role in orbital reconstruction. It is also a good method for reconstructing orbital fractures using MPI assisted by navigation technology.

Clinical characteristics and associated features of pure orbital roof fractures: A ten-year retrospective review

PURPOSE

To present the demographics and clinical characteristics of pure (rim-sparing) orbital roof fractures.

METHODS

This retrospective observational study used 10 years of data from a single institution. Patient age, sex, laterality, field of binocular single vision, associated injuries, and radiologic features were analyzed. Orbital roof fractures were categorized into four groups: comminuted/open, hinged, trapdoor, and linear. These were further subdivided into blow-in (-down) and blow-out (-up) fractures. Injury etiology was classified into fall, traffic accidents, sports injuries, assault, work-related, and others.

RESULTS

Data documented a low incidence rate of 2.5% (27 patients) in 1074 patients. Most patients were male (81%). The most common cause of injury was fall (48%), followed by traffic accidents (22%). Comminuted/open fractures constituted the bulk of fracture types (54%), followed by hinged, and linear fractures. Blow-in and blow-out fractures had an incidence rate of 50% each. Concomitant fractures of the medial and inferior orbital walls were predominant. Low surgical intervention was noted owing to acceptable field of binocular single vision outcomes, and the field of binocular single vision included the primary position of gaze in 88% of patients.

CONCLUSION

Pure orbital roof fractures occurred in 2.5% of patients with pure orbital fractures. Patients were predominantly male with trauma caused by high energy forces, which regularly caused comminution of the roof and fractures of the medial and inferior orbital walls. Most patients were managed conservatively.

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.

Association Between Socioeconomic Deprivation and Orbital Trauma in a Hospital-Based Population

PURPOSE

To examine the association between area-level socioeconomic deprivation and orbital trauma among emergency ophthalmology consults.

METHODS

We conducted a cross-sectional study using 5-year Epic data for all hospital-based ophthalmology consults at the University of Maryland Medical System, and the Distressed Communities Index (DCI) data for area-level socioeconomic deprivation. We ran multivariable logistic regression models adjusting for age to compute odds ratios (OR) and 95% confidence intervals (CI) for the association between the DCI quintile 5 distressed score and orbital trauma.

RESULTS

A total of 3,811 cases of acute emergency consults were identified, of whom 750 (19.7%) had orbital trauma and 2,386 (62.6%) had other traumatic ocular emergencies. The odds of orbital trauma among people living in a distressed community were 0.59 (95% CI 0.46-0.76) times the odds for those living in a prosperous community. Among White subjects, the odds of orbital trauma for people living in a distressed community were 1.71 (95% CI 1.12-2.62) times the odds for those living in a prosperous community; among Black subjects, the OR was 0.47 (95% CI 0.30-0.75; p-interaction = 0.0001). Among women, the OR for orbital trauma among those living in a distressed community was 0.46 (95% CI 0.29-0.71); among men, the OR was 0.70 (95% CI 0.52-0.97; p-interaction = 0.03).

CONCLUSION

Overall, we found an inverse association between higher area-level socioeconomic deprivation and orbital trauma among both men and women. The association varied by race, such that there was an inverse association with higher deprivation among Black subjects in contrast to a positive association among White subjects.

Insights into orbital morphological features and fracture patterns in medial and inferior wall fracture: a retrospective cohort study

This study investigated the orbital morphological features that lead to fractures at different sites by comparing patients with isolated inferior wall fracture (IWF) to patients with isolated medial wall fracture (MWF). This study analyzed the orbital morphologic characteristics of all orbital fracture patients who underwent orbital computed tomography (CT) scans between January 2017 and October 2022. On CT scans, the bony structures of the orbit were measured. We investigated the bilateral symmetry of orbital. In addition, orbital morphological differences were compared between patients with fractures of the medial wall and those with fractures of the inferior wall. A total of 135 patients with orbital fractures were included in the study. Of these, 91 were isolated MWFs and 44 were isolated IWF. We confirmed the symmetry of bilateral orbits and measured the orbit of the uninjured side. No differences were found between the MWF group and the IWF group in terms of ocular prominence, horizontal orbital diameter, orbital rim angle, sagittal orbital depth, sagittal orbital depth, and angle of inferior wall inclination. The distance between the infraorbital nerve (ION) entry point and the orbital rim was significantly smaller in the inferior lateral wall fracture group than in the MWF group (11.87 ± 2.54 vs 14.90 ± 4.64, P < 0.001), and the percentage of type 1 ION was significantly lower in the IWF group than in the MWF group (40.9% vs 65.9%, P = 0.012). We demonstrated the symmetry of bilateral orbits and found that when the point where the ION enters the infraorbital canal is near the orbital rim, patients are more prone to suffering a fracture of the inferior wall after orbital trauma. It is less likely for patients with type 1 ION to suffer an IWF following an orbital fracture.

Mechanisms of Development of Orbital Fractures: A Review

PURPOSE

The purpose of this study is to review the mechanisms in the development of orbital fractures.

METHODS

This is a comprehensive literature review that summarizes the mechanisms of developing orbital fractures.

RESULTS

There are 3 proposed mechanisms in the development of orbital fractures, which include the buckling, hydraulic, and globe-to-wall contact mechanisms. These mechanisms, as well as patient age, causes of injuries, and periorbital anatomy, influence the extent, sites, and patterns of orbital fractures.

CONCLUSION

A deeper understanding of these mechanisms helps us to detect and properly manage orbital fractures in the clinical setting.

Reconstruction of Medial Orbital Wall Using Autologous Perpendicular Plate of Ethmoid

The aim of this study is to investigate the feasibility of perpendicular plate of ethmoid as material for the reconstruction of medial orbital wall. The main outcome measurement was preoperative and postoperative orbital volume. The authors performed a study including 17 patients who have isolated medial orbital wall fracture (blow-out fracture). All the patients were fixed the defect using autologous perpendicular plate of ethmoid under endonasal approach. The authors compared the preoperative and postoperative orbital volume difference (unaffected orbit, affected orbit) of all the patients, and observed the improvement of diplopia or ocular motility disorders after operation. All 17 medial orbital wall reconstruction surgeries were successful with no severe postoperative ophthalmic complications. Statistically significant differences were found between the preoperative and postoperative orbital tissue volumes for the affected orbit. There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction. And postoperative computed tomography showed the implant is in place and there is no medial rectus incarceration. Autologous perpendicular plate of ethmoid proved to be safe and effective in the reconstruction of medial orbital wall under endonasal approach with cost-effectivence, low complication rate, high biocompatibility, and minimally invasion.

Saccade Analysis in Patients With Orbital-Wall Fractures Without Diplopia

PURPOSE

This study aimed to analyze saccades in patients with orbital-wall fractures with little or no ocular motor impairment.

METHODS

We included 7 eyes of 7 patients with unoperated orbital-wall fractures (3 cases of orbital-floor fractures and 4 cases of medial orbital-wall fractures) with mild or no diplopia who presented to our hospital between August 2019 and March 2021. Eye movements were assessed at the first visit and after 1 month using the Hess area ratio according to the Hess screen test, binocular single vision (BSV) scores (total 59 points) obtained using Goldman perimetry, and maximum velocity and amplitude of saccades within 15 degrees obtained using an eye tracker system.

RESULTS

Hess area ratio and BSV scores at the first visit and after 1 month were 88.6±8.2% and 97.4±3.6% and 49.6±8.5 points and 53.5±6.6 points, respectively, with no significant change (Hess area ratio, P =0.06; BSV, P =0.44). Next, the authors compared the velocity and amplitude of the saccades between the first visit and 1 month later and found no significant changes in any of the 4 directions (adduction, abduction, upgaze, and downgaze). Similarly, no significant differences were observed between the velocity and amplitude of the saccades between the injured and noninjured eyes, both at the first visit and after 1 month.

CONCLUSIONS

In patients with orbital-wall fractures with little or no eye movement impairment, eye tracker-based saccade analysis showed that the saccade velocity and amplitude did not change during the natural course of healing of the fracture.

Demographic and socioeconomic disparities in receipt of ophthalmology consultation for facial trauma

OBJECTIVE

Functional outcomes following facial and ocular trauma are time-sensitive and require prompt evaluation to minimise long-term vision loss, yet few studies have systematically evaluated disparities in the management of these cases. This study investigates whether a patient's race/ethnicity, primary language, insurance status, gender or age affects receipt of ophthalmology consultation for facial trauma.

METHODS AND ANALYSIS

This study was a retrospective cohort analysis of patients from the Elmhurst City Hospital Trauma Registry in Queens, New York who were seen for facial trauma including open globe injuries and orbital fractures between January 2014 and May 2016.

RESULTS

Of the 264 patients included, 43% reported as Hispanic, 23% white, 11% Asian, 8% black and 15% other/unknown. After controlling for confounding variables by multivariable logistic regression, neither race/ethnicity, gender, nor primary language were significantly associated with the likelihood of receiving an ophthalmology consult. However, patients with private insurance had 2.57 times greater odds of receiving an ophthalmology consultation than those with Medicaid or state corrections insurance (95% CI 1.37 to 4.95). As age increased, the likelihood of receiving an ophthalmology consultation decreased (p=0.009); patients 60 years of age and older had one-third the odds of ophthalmology consultation as younger patients (OR 0.33; 95% CI 0.16 to 0.68).

CONCLUSIONS

This study highlights that lack of ophthalmology consultation in patients with facial trauma is linked to age and underinsurance. Extra attention must be paid during primary assessments to ensure elderly patients and those with public insurance have equitable access to timely and appropriate care for facial trauma.

A Preoperative Imaging Evaluation to Avoid Orbital Complications in Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery has become popular worldwide. However, serious complications have been reported with it. A preoperative imaging evaluation is thus essential to avoid complications. The authors compared 0.5 mm slice computed tomography (CT) images reconstructed from sinus CT data with conventional 2 mm slice CT images. The authors evaluated patients who underwent endoscopic surgery. Data regarding age, sex, history of craniofacial trauma, diagnosis, operative procedure, and CT findings of eligible patients were extracted from medical records and retrospectively reviewed. One hundred twelve patients underwent endoscopic surgery during the study period. Six patients (5.4%) had orbital blowout fractures, and half of them could only be identified by 0.5 mm slice CT images. The authors presented the usefulness of 0.5 mm slice CT images in the preoperative imaging evaluation of functional endoscopic sinus surgery. Surgeons should also recognize that a small number of patients have "stealth" (asymptomatic and unrecognized) blowout fractures.

Pressure Onto the Orbital Walls and Orbital Morphology in Orbital Floor or Medial Wall Fracture: A 3-Dimensional Printer Study

The purposes of this study were to compare the pressure onto the orbital floor and medial orbital wall between 3-dimensional printer skull models with unilateral orbital floor and medial orbital wall fractures and to compare the morphology of the orbital floor and medial orbital wall between patients with unilateral orbital floor and medial orbital wall fractures. The skull models were created based on computed tomographic (CT) data obtained from every 10 patients with unilateral orbital floor and medial orbital wall fractures. The orbital spaces of these models were filled with silicone, the silicone surface was pushed down, and pressures onto the orbital floor and the medial orbital wall were measured. On preoperative computed tomographic images taken in the same 20 patients, the superior and lateral bulges of the orbital floor and medial orbital wall were measured, respectively. The measurements were done on the unaffected sides. Consequently, the pressure onto the orbital floor was significantly higher in the orbital floor fracture models than in the medial orbital wall fracture models, although the pressure onto the medial orbital wall was not significantly different between the models. As for the morphologic study, the superior bulge of the orbital floor was higher in the orbital floor fracture group than in the medial orbital wall fracture group. The results of this study indicate that since the orbital floor with a high superior bulge receives high hydraulic pressure, patients with a high superior bulge have a greater risk of orbital floor fracture.

The Incidence and Risk Factors of Medial and Inferior Orbital Wall Fractures in Korea: A Nationwide Cohort Study

Purpose: We aimed to investigate orbital wall fracture incidence and risk factors in the general Korean population. Method: The Korea National Health Insurance Service–National Sample Cohort dataset was analyzed to find subjects with an orbital wall fracture between 2011 and 2015 (based on the diagnosis code) and to identify incident cases involving a preceding disease-free period of 8 years. The incidence of orbital wall fracture in the general population was estimated, and the type of orbital wall fracture was categorized. Sociodemographic risk factors were also examined using Cox regression analysis. Results: Among 1,080,309 cohort subjects, 2415 individuals with newly diagnosed orbital wall fractures were identified. The overall incidence of orbital wall fractures was estimated as 46.19 (95% CI: 44.37–48.06) per 100,000 person-years. The incidence was high at 10–29 and 80+ years old and showed a male predominance with an average male-to-female ratio of 3.33. The most common type was isolated inferior orbital wall fracture (59.4%), followed by isolated medial orbital wall fracture (23.7%), combination fracture (15.0%), and naso-orbito-ethmoid fracture (1.5%). Of the fracture patients, 648 subjects (26.8%) underwent orbital wall fracture repair surgeries. Male sex, rural residence, and low income were associated with an increased risk of orbital wall fractures. Conclusions: The incidence of orbital wall fractures in Korea varied according to age groups and was positively associated with male sex, rural residency, and low economic income. The most common fracture type was an isolated inferior orbital wall fracture.

Orbital haematoma after orbital fracture repair using silicone, polytetrafluorethylene, and poly-L-lactic acid/hydroxyapatite implants

The purpose of this paper was to report the incidence of orbital haematoma formation following the repair of orbital fractures with silicone, polytetrafluorethylene (PTFE), and poly-L-lactic acid/hydroxyapatite (PLLA/HA) implants. This retrospective review examined 234 patients (235 sides) who underwent repair of orbital wall fractures over a six-year period. Of these, 36 patients received a silicone sheet; 49 patients received a silicone sheet with superimposed PTFE implant; and 149 patients (150 sides) received PTFE with or without an underlying PLLA/HA implant. Orbital haematomas were documented in 13 out of 36 patients (36.1%) who underwent fracture repair with a silicone sheet; seven out of 49 patients (14.3%) who had a silicone sheet with a superimposed PTFE implant; and three out of 150 sides (2.0%) with PTFE with or without underlying PLLA/HA. The difference in incidence of orbital haematoma formation was significant among the groups (p < 0.001, Pearson's chi squared test). In the silicone sheet group, haematomas formed within two weeks of surgery in 11 patients (84.6%). In the silicone sheet with superimposed PTFE implant group, five patients (71.4%) developed orbital haematomas no earlier than after two weeks postoperatively. This study showed that the incidence of orbital haematoma formation following orbital fracture repair is different among the implant materials. The use of PTFE and PLLA/HA implants may minimise this complication.

Isolated-check visual evoked potential: a more sensitive tool to detect traumatic optic neuropathy after orbital fracture

PURPOSE

To establish a more sensitive diagnostic tool for traumatic optic neuropathy (TON), we explored the diagnostic efficacy of isolated-check visual evoked potential (ic-VEP) for TON in orbital fracture and compared ic-VEP with pattern-reversal visual evoked potential (P-VEP) testing.

METHODS

This was a prospective single-center study. A total of 137 eyes from 131 patients diagnosed between December 2016 and October 2019 with orbital fractures were included in the study. Injury history, best-corrected visual acuity (BCVA), visual field, computed tomography (CT), P-VEP, and ic-VEP data were collected. Parameters of ic-VEP (signal-to-noise ratio [SNR]) and P-VEP (peak latency and amplitude of P100) were compared and diagnostic accuracy was analyzed.

RESULTS

TON was associated with worse BCVA than non-TON (median 0.52 versus 0.10 logMAR, P < 0.001). SNRs were negatively associated with the P100 peak latency while positively associated with the P100 amplitude. The sensitivity of ic-VEP for TON (79.6%) was higher than that of P-VEP (61.2%, P = 0.049), although this difference was not statistically significant after Bonferroni correction. Using ic-VEP and P-VEP together could increase sensitivity (87.8%). Maximum areas under curve were obtained using the SNR criteria of 1.3, 1.47, and 1.54 at 8%, 16%, and 32% depth of modulation, respectively.

CONCLUSION

ic-VEP was more sensitive than P-VEP in diagnosing TON, and a combination of the two examination tests was recommended. The use of ic-VEP as the new diagnostic standard technique for TON should be considered.

Prevalence and severity of orbital blowout fractures

We aimed to study the prevalence of orbital blowout fractures and evaluate the causes and the location of orbital cavity fractures. In this cross-sectional study, the medical records of all patients admitted with facial trauma were assessed, sociodemographic information as well as the aetiology of trauma extracted, and the computed tomographic images of the patients were reassessed. Location of orbital blowout fractures and the severity of orbital fractures were evaluated. A total of 203 cases had blowout fractures (175 male and 28 female patients with a mean (SD) age of 36 (16) years. Road traffic accidents (n=139, 69%) were the most common cause of orbital blowout fractures. Falls (n=29, 14%) and assault (n=20, 10%) were the other causes of trauma to the orbital structure, which resulted in blowout fractures. The medial wall was the most commonly involved location (n=81, 40%) followed by orbital floor (n=64, 32%), the combination of medial wall and floor (n=36, 18%), medial wall and maxilloethmoidal strut combination (n=13, 6%), and all the three locations altogether (n=9, 4%). Most of the blow-out fractures had mild severity (n=107, 53%). There was a significant relation between the severity and location of the blowout fractures (p<0.001).

Application of three-dimensional printing technology in orbital floor fracture reconstruction

Importance

Orbital floor fracture is common among patients suffering from facial trauma. Open reduction and reconstruction of the orbital floor with Medpor is the treatment of choice in our centre to correct diplopia and enophthalmos.

Objective

Application of locally available 3D printing service in perioperative planning of orbital floor reconstruction with porous polyethylene.

Design

We present two patients who suffered from orbital floor fracture complicated by diplopia. Open reduction and orbital floor reconstruction with Medpor was performed with the guidance of a 3D printed customized model of the orbital floor defect.

Participants

Both patients were admitted through the Emergency Department to surgical ward after facial trauma. CT scan of the face showed orbital floor fracture with entrapment of inferior rectus muscle. Clinically patients also suffered from diplopia on extreme gaze.

Results

With the aid of 3D printed model, it shortened operative time and duration of anaesthesia. Defect-specific Medpor could be trimmed and molded easily from the model and thus reduced fatigue of the material. Furthermore, the model was helpful in patient education and explanation of the surgical procedure.

Conclusions and relevance

Application of 3D printing in medical specialties is rapidly developing in the past few years. In orbital floor fracture reconstruction, 3D printed model provides a customized solution, decreases operative time and duration of anaesthesia.

Role of Negative Orbit Vector in Orbital Blow-Out Fractures

BACKGROUND

Negative orbit vector is defined as the most anterior globe portion protrudes past the malar eminence. The aim of the study was to evaluate the relationship between negative orbit vector and blow-out fracture location analyzing the distance between the anterior corneal surface and orbital bone with facial soft tissue in medial and orbital floor blow out fractures using orbital computed tomography (CT).

METHODS

Seventy-seven patients diagnosed with blow-out fractures involving the medial or orbital floor were included. Distances from the anterior cornea to lower lid fat, inferior orbital wall, inferior orbital rim, and anterior cheek mass were measured using orbital CT scans. The proportion of negative orbit vector and measured distanced were compared between medial wall fracture and orbital floor fracture. Medical records including age, sex, concomitant ophthalmic diagnosis, and nature of injury were retrospectively reviewed.

RESULTS

Forty-three eyes from 43 patients diagnosed with medial wall fracture and 34 eyes from 34 patients diagnosed with orbital floor fracture were included. There was no significant difference in the distance from the anterior cornea to lower lid fat (P = 0.574), inferior orbital wall (P = 0.494), or orbital rim (P = 0.685). The distance from anterior cornea to anterior cheek mass was significantly different in medial wall fracture (-0.19 ± 3.49 mm) compared with orbital floor fracture (-1.69 ± 3.70 mm), P = 0.05. Negative orbit vector was significantly higher in orbital floor fracture patients (24 among 34 patients, 70.6%) compared with those with medial wall fractures (19 among 43 patients, 44.2%) (P = 0.04).

CONCLUSIONS

Patients presenting with a negative orbit vector relationship when the most anterior portion of globe protruded past the anterior cheek mass and malar eminence were more likely to develop orbital floor fracture than medial wall fracture.

The Paradoxical Predominance of Medial Wall Injuries in Blowout Fracture

PURPOSE

To evaluate the type and cause of orbital blowout fractures in Korea.

DESIGN

Retrospective, observational case series.

METHODS

Patients who underwent reconstruction for blowout fracture from March 2004 to April 2013 at Korea University Guro and Ansan Hospitals were included in this study. Patient demographics and orbital computed tomography (CT) scans were reviewed. On CT, ethmoid air cell septa, blowout fracture type, and other combined fractures were analyzed. Blowout fracture was classified as affecting up to 4 areas: the floor lateral to the infraorbital canal, the floor medial to the canal, the maxilla-ethmoidal strut ("inferomedial" strut), and the medial wall. Furthermore, trauma type and associated injury were reviewed. The results of adolescent patients and adult patients were compared, as were those of males and females.

RESULTS

The study included 659 eyes of 659 patients; mean patient age was 31.01 ± 14.27 years. In total, 513 (77.85%) patients were male and 146 (22.15%) were female. The most common blowout fracture type was medial wall fracture, followed by floor wall, floor and medial wall without inferomedial strut, and floor and medial wall fracture with inferomedial strut, in that order. Interestingly, patients with floor wall blowout fracture were younger (26.87 ± 12.90 y) than other groups: medial wall fracture (32.35 ± 14.64 y, P < 0.0001), floor and medial wall fracture (35.22 ± 14.49 y, P < 0.0001), and floor and medial wall fracture involving the maxillaethmoidal strut (32.62 ± 13.75 y, P = 0.002). The number of ethmoidal air cell septa was lowest in the medial wall fracture group (3.62 ± 0.67): floor wall fracture (4.07 ± 0.69, P < 0.0001), floor and medial wall fracture (3.90 ± 0.78, P < 0.0001), and floor and medial wall fracture involving the maxilla-ethmoidal strut (4.05 ± 0.72, P = 0.001).

CONCLUSIONS

Our study demonstrated that the blowout fracture type distribution in Korea varied from the results of many other studies. Medial wall fracture is the most common among the 4 types, and anatomic variance, such as number of ethmoid air cell septa, could influence blowout fracture type, especially in medial wall fracture.