The estimation of postoperative bleeding after reduction of blowout fracture: the effectiveness of negative-pressure drainage system

Delayed-type retrobulbar hematoma caused by low temperature after reconstruction of inferior blow-out fracture

Retrobulbar hemorrhage is a disastrous condition that can lead to permanent blindness. As such, rapid diagnosis and treatment are critical. Here, we report a patient who presented with retrobulbar hemorrhage following an orbital floor fracture. Restoration of inferior orbital wall with porous polyethylene implant was underwent. Four days after the orbital floor reconstruction, the patient smoked a cigarette outdoors in –3˚C weather. Cold temperature and smoking caused an increase in his systemic blood pressure. The elevated blood pressure increased intraorbital pressure to the extent of causing central retinal artery occlusion and exacerbated oozing. During exploratory surgery, 3 mL of hematoma and diffuse oozing without arterial bleeding were observed. Prompt diagnosis and treatment prevented vision impairment. Few studies have reported on the risk factors for retrobulbar hemorrhage. This case showed that daily activities, such as exposure to cold weather or tobacco smoking, could be risk factors for retrobulbar hemorrhage.

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).

Factors Influencing Postsurgical Diplopia in Orbital Floor Fractures and Prevalence of Other Complications in a Series of Cases

PURPOSE

We conducted a review of orbital fractures treated in our hospital over a period of 4 years. We reviewed several complications of such fractures, especially the relationship of postsurgical diplopia with different presurgical variables: age, gender, type of fracture, fracture area, coronal and sagittal diameter of fracture, fractured floor area, time to surgery, presence of muscle herniation, and presence of muscle entrapment.

PATIENTS AND METHODS

Fractures involving the orbital floor remain a controversial issue in terms of surgical treatment and the time from trauma to surgery. Surgical indications are divided into esthetic and functional, and they greatly differ from one medical center to another. We observed that the variables that influence postoperative complications varied in the different studies reviewed. Postsurgical diplopia is one of the most important complications, and its relationship with presurgical variables was the focus of this study. For the purpose of this study, we performed bivariate and multivariate analyses, accepting P < .05 as significant.

RESULTS

According to the multivariate analysis, postsurgical diplopia was only associated with trapdoor fractures, regardless of all other variables, especially if these fractures were operated on after 48 hours. In addition, the bivariate analysis showed that fractures involving muscle herniation resulted in less diplopia and a better prognosis if operated on before 48 hours. However, these results were not statistically significant.

CONCLUSIONS

Surgery performed within 48 hours of trauma statistically improves fractures with true muscle entrapment and also, fractures with muscle hernation (although in this fractures, the improvement is not statistically significant).