Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis

Orbital floor fractures-a comparison between CT images and findings at surgery

PURPOSE

The present study aims to investigate how well CT images correlate to surgical findings in orbital floor fractures and to the presence of diplopia.

METHODS

In this cross-sectional study, 27 consecutive patients already selected for surgery due to an orbital floor fracture underwent a routine CT scan (axial, coronal, sagittal). An ophthalmologist established any presence of diplopia. Extent of fracture/injury seen on CT was compared to that discovered during surgery.

RESULTS

In the surgeons´ opinions CT-images were in concordance with surgical findings in 71% of the cases. Agreement for pure blow out fractures was high (92%). Tetrapod fractures as a cause of an orbital floor fracture was only identified as such by surgeons in three of 11 cases, all subjected to orbital exploration, not only a closed reduction. Diplopia showed a significant correlation to rounding of the inferior rectus muscle at coronal CT. "Rounding" significantly correlated with the presence of a floor defect, to herniation of soft tissues and to the volume of displaced tissue.

CONCLUSIONS

The results imply that the joint professional interaction between neuroradiology and surgery is important and would benefit from the use of an easy and well-defined classification system of orbital floor fractures. In Sweden a national record to collect data on all zygomaticomaxillary complex fractures assessed is to be started aiming at making general statements possible by time.

Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort?

Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons’ view on the necessity of medial orbital wall repair often is restricted and an aesthetically disturbing enophthalmos is more likely to be accepted. Therefore, treatment options range from leaving the medial wall without repair to reconstruction with autogenous tissue or alloplastic materials, which can lead to moderate to severe side effects. However, emerging technologies such as patient-specific implants (PSI) offer a reliable and anatomically correct reconstruction of the bony orbit. This study aimed to evaluate the outcome of full orbital reconstruction using PSIs compared to only orbital floor repair using PDS (bioresorbable polydioxanone) foils leaving the medial orbital wall untouched in traumatic two-wall orbital fractures. Of all patients treated at the University Hospital of Düsseldorf between 2017 and 2019 who suffered from traumatic orbital fracture, only patients with a two-wall orbital fracture involving both the orbital floor and the medial wall (n = 68) were included. Patients were treated either with a PSI (n = 35) or a PDS foil (n = 33). Primary outcome parameters were ophthalmological disturbances analyzed via clinical investigation and intra-orbital angles, volumes and implant position analyzed with radiological 3D-datasets. While a two-wall reconstruction using PSIs led to a significant improvement of the enophthalmos, the rate of postoperative enophthalmos was significantly increased in cases of only orbital floor repair with PDS foils. Radiologically, a significant reconstruction of the three-dimensional bony orbit succeeded with the simple use of PSIs leading to a significant reduction in the traumatically enlarged orbital volume. PSI also led to a significant reduction in the traumatically enlarged medial angle of the orbit. This was not the case for single-floor repair with PDS foil. The results of this study suggest that complex orbital fractures can be reconstructed at an even higher degree of accuracy with selective laser-melted PSIs than PDS foils. In order to achieve a true to original reconstruction of the bony orbit, surgical treatment of the medial orbital wall can be advocated for in the long term depending on the indication.

Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions

OBJECTIVE

This retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification.

MATERIAL AND METHODS

CT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the "defect body" method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis.

RESULTS

A total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures - W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm² to 6.09 cm² for orbital floor and from 0.29 cm² to 5.43 cm² for medial wall fractures. The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm², W2(i) = 1.64 cm², W1(i)2(i) = 3.10 cm², W1(m) = 1.36 cm², W2(m) = 1.65 cm², W1(m)2(m) = 2.98 cm², W1 (im) = 3.35 cm², W1 (im) 2(i) = 4.63 cm², W1 (im)2(m) = 4.06 cm² and W1 (im)2 (im) = 7.16 cm².

CONCLUSION

The AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.

Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and "Hybrid" Patient-Specific Implants

The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending guides. The main outcome measures were preoperative and postoperative orbital volume and surgery time. We performed a retrospective cohort study including 22 patients who had undergone surgery between May 2016 and November 2018. The first twelve patients underwent conventional reconstruction with intraoperative free-hand bending of an orbital floor mesh plate. The subsequent ten patients received pre-contoured plates based on 3D-printed orbital models that were produced by mirroring the non-fractured orbit of the patient using a medical imaging software. We compared the preoperative and postoperative absolute volume difference (unfractured orbit, fractured orbit), the fracture area, the fracture collapse, and the effective surgery time between the two groups. In comparison to the intraoperative bending of titanium mesh, the application of preformed plates based on a 3D-printed orbital model resulted in a non-significant absolute volume difference in the intervention group (p = 0.276) and statistically significant volume difference in the conventional group (p = 0.002). Further, there was a significant reduction of the surgery time (57.3 ± 23.4 min versus 99.8 ± 28.9 min, p = 0.001). The results of this study suggest that the use of 3D-printed orbital models leads to a more accurate reconstruction and a time reduction during surgery.

[Application of bone grafts from chin of the mandible in the reconstruction of orbital fracture]

OBJECTIVE

To evaluate the clinical effects of bone graft from the mandible in repairing orbital floor defects.

METHODS

Bone grafts from the mandible were used to treat 11 cases of orbital floor defects and followed up for 6-12 months.

RESULTS

The surgical incisions healed primarily in all 11 patients. The orbital floor structure was restored. No vision loss, limited eye movement, implant infection, or resorption were observed postoperatively, and no complications occurred in the supply area.

CONCLUSIONS

Bone grafts from the mandible were an ideal material to repair orbital floor defects.

A Protocol to Reduce Interobserver Variability in the Computed Tomography Measurement of Orbital Floor Fractures

Orbital fracture detection and size determination from computed tomography (CT) scans affect the decision to operate, the type of surgical implant used, and postoperative outcomes. However, the lack of standardization of radiological signs often leads to the false-positive detection of orbital fractures, while nonstandardized landmarks lead to inaccurate defect measurements. We aim to design a novel protocol for CT measurement of orbital floor fractures and evaluate the interobserver variability on CT scan images. Qualitative aspects of this protocol include identifying direct and indirect signs of orbital fractures on CT scan images. Quantitative aspects of this protocol include measuring the surface area of pure orbital floor fractures using computer software. In this study, 15 independent observers without clinical experience in orbital fracture detection and measurement measured the orbital floor fractures of three randomly selected patients following the protocol. The time required for each measurement was recorded. The intraclass correlation coefficient of the surface area measurements is 0.999 (0.997-1.000) with p-value < 0.001. This suggests that any observer measuring the surface area will obtain a similar estimation of the fractured surface area. The maximum error limit was 0.901 cm(2) which is less than the margin of error of 1 cm(2) in mesh trimming for orbital reconstruction. The average duration required for each measurement was 3 minutes 19 seconds (ranging from 1 minute 35 seconds to 5 minutes). Measurements performed with our novel protocol resulted in minimal interobserver variability. This protocol is effective and generated reproducible results, is easy to teach and utilize, and its findings can be interpreted easily.

Relative difference in orbital volume as an indication for surgical reconstruction in isolated orbital floor fractures

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients' computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear.

Management of diplopia in patients with blowout fractures

PURPOSE

To report the management outcomes of diplopia in patients with blowout fracture.

MATERIALS AND METHODS

Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months.

RESULTS

Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery.

CONCLUSIONS

In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.

Early versus late repair of orbital blowout fractures

BACKGROUND AND OBJECTIVE

To compare early and late surgical repair of orbital blowout floor fractures.

PATIENTS AND METHODS

A retrospective, comparative interventional case series reviewed medical records of 50 consecutive patients who underwent unilateral orbital floor fracture repair in a 4-year period. Comparative analysis was performed between patients operated on within 2 weeks of injury and those operated on at a later stage.

RESULTS

Assault, motor vehicle accidents, and sports injuries were the most common causes of injury. Surgery was performed due to inferior rectus muscle entrapment and limitations in up gaze in 20 (40%) patients or to prevent enophthalmos in cases with significant bony orbital expansion in 30 (60%) patients. After surgery, enophthalmos improved an average of 0.8 mm. Limitation in ocular motility improved after surgery but was statistically significant only in up gaze. Patients who underwent early repair (within 2 weeks) achieved less improvement in enophthalmos versus patients who underwent late repair (delta enophthalmos of 0.2 +/- 1.1 vs 1.3 +/- 1.9 mm, respectively; P = .02).

CONCLUSION

In these patients, postoperative vertical ductions and postoperative enophthalmos improved after fracture repair. Surgery was associated with a low rate of postoperative complications. No apparent difference in surgical outcome was seen between early (within 2 weeks) and late surgical repair.

Finger, Sex, and Side Differences in Fingertip Size and Lack of Association with Image-Based Digit Ratio (2D:4D) Measurements

Different methods for measuring the second-to-fourth digit ratio (2D:4D), a putative marker for prenatal androgen exposure, may lead to varying values of 2D:4D. Specifically, it has been hypothesized that fingertip fat pads may be differentially deformed when taking palm images (photocopies or flatbed scans), but not when fingers are measured directly, thus yielding lower 2D:4D values from image-based measurements rather than direct ones. A measurement protocol for fingertip size is unavailable, as are data on finger and sex differences in this trait. Introducing such a protocol, this study found very large finger differences in adult fingertip size (largest for 4D, smaller for 3D and 5D, smallest for 2D), large side differences (larger in the left than in the right hand of right-handed subjects), but only small and not significant sex differences. Fingertip size was unrelated to image-based 2D:4D measurements, suggesting that fingertip size and the extent of finger and sex differences therein are unlikely to explain discrepant 2D:4D values obtained from image-based versus direct measurements.

Orbital floor reconstruction: a retrospective study of 21 cases

OBJECTIVE

The purpose of this retrospective study was to investigate the diagnostic methods, therapeutic principles, surgical approach, and materials used for orbital floor reconstruction.

STUDY DESIGN

This study consisted of 21 cases with orbital fractures treated at the Hospital of Stomatology, Sichuan University, China, between July 2002 and June 2006. Inclusion criteria were patients with fractures of the orbital floor with bone defects. Patients were retrospectively analyzed for gender, age, mechanism of injury, classification of fracture, and complications.

RESULTS

CT scans were 100% accurate in diagnosing the fractures. Shaped autogenous bone, titanium mesh, and Medpor were respectively implanted under the periosteum of the orbital floor in 5 cases, 10 cases, and 6 cases. All the patients had good results including significant improvements in appearance and function after surgery. There were no severe permanent complications. Two cases had postoperative wound infections, and 1 case had temporary blindness that resolved completely.

CONCLUSIONS

CT scan is the first choice of investigation for an orbital floor fractures. The objectives of treatment for an orbital floor fracture with a bony defect are reduction of the prolapsed orbital contents and reconstruction of the orbital floor with repair materials, to restore the normal orbital floor and orbital capacity. A subciliary incision was adopted in our surgery. At present, porous polyethylene and titanium mesh are considered to be the ideal orbital floor repair materials. Titanium mesh was used in fractures with large defects that were not easy to fix without obvious enophthalmos. Porous polyethylene can be used in fractures when there is a need to restore the orbital volume.

Secondary post-traumatic enophthalmos: high-resolution magnetic resonance imaging compared with multislice computed tomography in postoperative orbital volume measurement

PURPOSE

Multislice computed tomography (MSCT) was the modality of choice for orbital volume measurement. This first prospective study compares MSCT with high-resolution magnetic resonance imaging (MRI) combined with micro (MRImc) and headcoil (MRIhc) in volumetric evaluation of the postsurgical enophthalmic orbit.

PATIENTS AND METHODS

Morphologic and dimensional changes of the orbit, eyebulb, and fat content were investigated 3 to 4 months after reconstruction of complex orbital fractures in 36 patients. Image analysis and volumetric assessment from 2-dimensional and 3-dimensional-MRImc and MRIhc were compared with MSCT. The volume segmentation algorithm operated on multispectral, 3-dimensional MR data acquired at isotropic proton density weighted acquisitions.

RESULTS

CT and MRI volume data correlated significantly (P < .01). Enlargement of the posterior segment often resulted in orbital geometry change from conical to convex. Even cases of correct orbital reconstruction presented significant volume enlargement compared to the contralateral side (P < .01). The retro bulbar fat showed itself fragmented and was dislocated in the medial posterior region mostly. We found reduced sagittal eye projection, increased width of the orbital rim, and dislocation of the posteromedial orbital floor (P < .01). High correlation was detected between orbital volume increment and degree of enophthalmos (0.93 mm per 1 cm3 orbital volume enlargement diameter) (P < .01).

CONCLUSIONS

As MRI orbital volume measurement permitted prediction of postsurgical enophthalmos, which is related to possible failure in orbital volume correction and reduction of the posterior medial bulge and not to fat content changes, it is suited for planning secondary correction.

Traumatic dislocation of the globe into the maxillary sinus

The complete traumatic dislocation of the globe into the maxillary sinus is a very rare event. Due to the intense force affecting the orbit, the impact on the globe and its accompanying structures is normally very severe. A case is reported of complete dislocation of the globe into the maxillary sinus with nearly complete recovery of vision and motility.

Reconstruction of Internal Orbital Wall Fracture with Iliac Crest Free Bone Graft: Clinical, Computed Tomography, and Magnetic Resonance Imaging Follow-Up Study

BACKGROUND

The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft.

METHODS

Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes.

RESULTS

Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (> 1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (> 10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study.

CONCLUSIONS

The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (< or = 2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.

Point-to-Point Computer-Assisted Navigation for Precise Transfer of Planned Zygoma Osteotomies from the Stereolithographic Model into Reality

PURPOSE

To evaluate the feasibility and accuracy of a new method for planning and realizing zygomatic osteotomies in cases of established post-traumatic deformities using stereolithographic (SL) models and computer assisted navigation.

PATIENTS AND METHODS

In 5 patients, osteotomy and repositioning of the zygomatic complex was planned using SL models. The desired position of the zygoma in the patient was determined by fixing individualized osteosynthesis plates to predefined screw positions. The SL model and the patient were registered to the same 3-dimensional computed tomography data set via an occlusal reference frame on the patient and corresponding reference markers on the model. Prebent osteosynthesis plates from the surgical simulation on the model were fixed to corresponding screw positions on the patient, which were located by computer-assisted navigation. Evaluation of accuracy was performed by image fusion of postoperative computed tomography scans of the model and the patient.

RESULTS

Clinical outcome was satisfactory in all cases. The evaluation by image fusion showed alignment of the patient's and the model's zygoma in 4 of 5 cases. Mean measured distance between screw positions in the models and the patients were 1.1 +/- 0.3 mm for 44 screws. In 1 patient the treatment plan was changed intraoperatively because of unforeseen soft tissue limitations.

CONCLUSION

Point-to-point navigation is an accurate method to transfer the planning of a complex osteotomy from the SL model to the actual surgical procedure. Surgery is facilitated considerably because repositioning and osteosynthesis are achieved in 1 step.

Individual CAD/CAM Fabricated Glass-Bioceramic Implants in Reconstructive Surgery of the Bony Orbital Floor

BACKGROUND

The aim of the study was to present a set of preliminary cases from an ongoing program of reconstructive procedures using a new technique in the treatment of severe enophthalmos and diplopia after the primary treatment of orbital floor fractures had rendered insufficient results.

METHODS

Glass-bioceramic implants were shaped from computed tomography coordinates with computer-assisted design and computer-assisted manufacturing. In this prefabrication process, the implants were milled individually out of a solid block of Bioverit II (3di Gmbh, Jena, Germany). The adequacy of this reconstruction for treating malfunction and aesthetic deficits was evaluated.

RESULTS

Eight patients with orbital floor fractures underwent successful surgery. The results were encouraging, with all patients showing a good functional and aesthetic outcome.

CONCLUSIONS

Computer-assisted design/computer-assisted manufacturing implants made of Bioverit II can be used for a very accurate and successful secondary reconstruction of the orbital floor. However, it addresses only a few aspects of the treatment of orbital floor fractures and should be considered as an equal alternative to other reconstruction methods.

A novel high-resolution magnetic resonance imaging microscopy coil as an alternative to the multislice computed tomography in postoperative imaging of orbital fractures and computer-based volume measurement

BACKGROUND

Multislice computed tomography (MSCT) has been the modality of choice for postoperative detailed imaging of orbital trauma. Unfortunately, it involves extensive exposition of the lens to radiation, especially when taking multiple readings. Also, it holds beam hardening effects and limited imaging (delineation) of the reconstruction material. Alternative conventional magnetic resonance imaging (MRI) head coils (MRIhc) present reduced differentiation of anatomic structures caused by low signal and artifact appearance. A substantially improved depiction is made possible by a newly introduced MRI microscopy coil (MRImc), used for the first time in this field.

PATIENTS AND METHODS

In this prospective study, 32 patients with extended orbital wall fractures (n = 36) were treated surgically using a polydioxanonsulfate (PDS) foil after reconstruction. Postoperatively, imaging was performed using MRImc, conventional MRI, and MSCT to evaluate the different imaging techniques.

RESULTS

The position of the PDS foil could precisely be depicted in 29 of 36 fractures by MRImc, whereas by conventional MRI and MSCT the reconstruction material could only be detected in 25 and 24 of 36 fractures, respectively. In contrast to MRIhc, the new microscopy coil allows fast and high resolution imaging and therefore a clear differentiation of eventual postoperative complications (eg, dislocation of the PDS foil with secondary soft tissue entrapment resulting in limitation of ocular movements or enophthalmos). In 13 long lasting symptomatic cases, revision surgery could be avoided because of regular MRImc findings, apart from muscle swelling and hematoma. In 11 cases of inadequate PDS foil position resulting in revision, the mean volume of displaced tissue (VDT) of 0.62 cm3 correlated significantly to an enophthalmos of more than 2 mm.

CONCLUSION

In this pilot study, MRImc proved to be highly superior to MRIhc and MSCT in postsurgical orbital imaging, especially for decision making regarding revision surgery.

Update on orbital trauma

PURPOSE OF REVIEW

To evaluate the recent developments in the evaluation and treatment of orbital trauma from April 2003 to March 2004. The scope of orbital trauma included a MEDLINE search under the keywords of zygoma and orbital fracture, and traumatic optic neuropathy.

RECENT FINDINGS

Preoperative volume assessment with computed tomography of orbital fractures can help surgical planning of volume replacement. Ultrasonography can visualize anterior orbital fractures, including rim and zygoma trauma. Orbital trauma has a high incidence of concurrent ocular trauma. Fractures in the presence of the oculocardiac reflex, persistence nausea/vomiting, or entrapped soft tissue require urgent repair. Endoscopic-assisted repair of orbital fractures offers an alternative approach to orbital fracture repair.

SUMMARY

Advances in ultrasonography and computed tomography allow better visualization of orbital fractures for better preoperative evaluation and intraoperative repair. Progress in endoscopic techniques offers alternatives in orbital fracture repair. New materials allow for options in orbital reconstruction. Unfortunately, few advances in the management of traumatic optic neuropathy were found in this review.

Epidemiology and management of orbital fractures

PURPOSE OF REVIEW

Orbital fractures are usually associated with ocular and intracranial injuries. The recent literature on orbital fractures is analyzed with emphasis on epidemiology, assessment, and surgical management.

RECENT FINDINGS

In most countries, traffic accidents are the leading cause of orbital fractures. Orbitozygomatic fractures are extremely frequent but rarely addressed in the ophthalmic literature. CT scanning remains the gold standard for assessing orbital fractures, especially with the new CT technology (multislice CT), which has improved the acquisition of coronal images of the orbit without the need for hyperextension of the neck. Several different surgical strategies are used to repair orbital fractures. Porous polyethylene implants continue to be approved by most surgeons.

SUMMARY

Orbital fractures are usually part of more complex midfacial trauma. Depending on the main characteristics of the trauma, orbital fractures are managed by different specialists who adopt distinct surgical approaches. Taking into consideration that most complications of these fractures are related to the globe, oculoplastic surgeons in collaboration with other medical specialists are in a prime position to assess and manage these cases.