Comparison of the results of the treatment of enophthalmos in orbital blowout fracture in children/adolescents and adults

BACKGROUND

Orbital fractures are common injuries in adults and children. Although the mechanism of blowout fracture is generally similar regardless of age, due to differences in anatomy, clinical symptoms of these fractures vary in the 2 groups of patients. Numerous articles describe the methods of orbital reconstruction leading to enophthalmos correction; however, the current literature lacks articles presenting the comparison of enophthalmos treatment results in adults and children with orbital blowout fracture.

OBJECTIVES

The aim of this study was to compare the results of the treatment of enophthalmos in orbital blowout fracture in children/adolescents and adults with regard to the location of the fracture, the time from the injury to surgical treatment, the type of surgical procedure, and the donor location of an autogenous bone graft.

MATERIAL AND METHODS

The treatment results of 2 groups were compared: 530 adults (patients over 18 years of age; 18-77 years; average age: 34 years); and 200 children/adolescents (4-18 years; average age: 12.1 years). Data was obtained retrospectively through a review of the medical history of patients treated for a fracture of the orbital floor and/or medial wall in our department in the years 1975-2015.

RESULTS

In patients with post-traumatic enophthalmos, the correct positioning of the eyeball was achieved in 313 adults (59.1%) and 139 children (69.5%), improvement in 159 adults (30%) and 49 children (24.5%), and no improvement in 58 adults (10.9%) and 12 children (6%). Recovery after surgical treatment was achieved in 311 adults (60.9%) and 94 children (52.8%), improvement in 120 adults (23.5%) and 59 children (33.1%), and no improvement in 80 adults (15.7%) and 25 children (14%).

CONCLUSIONS

The relationship between post-traumatic enophthalmos and the location of the fracture was more significantly marked in the adult group. In cases that required bone graft reconstruction, better results were achieved in adults. Cite as.

Surgical treatment of enophthalmos in children and adolescents with pure orbital blowout fracture

PURPOSE

This study evaluated outcomes of surgical treatment for enophthalmos after pediatric orbital blowout fracture. Associations of fracture type, fracture site, time from injury to treatment, and type of surgical procedure with treatment outcomes were assessed.

METHODS

The medical records of 200 children and adolescents (38 girls and 162 boys) with orbital fractures treated in the authors' department from 1975 to 2015 were reviewed retrospectively. The main causes of injury were accidental blows to the orbit and sports injuries. This study included only patients with fracture of the floor and/or medial wall of the orbit, which is referred to in the English literature as pure, or internal, blowout fracture. Patients with fracture of the orbital rim, lateral wall, or roof were excluded. Surgical treatment was performed for 178 patients; the other 22 children were treated conservatively.

RESULTS

In the surgically treated group, treatment outcomes did not differ in relation to the severity of post-traumatic enophthalmos. The setting of the eyeball improved in 83% of patients.

CONCLUSION

The severity of post-traumatic enophthalmos was not associated with surgical outcome in children.

Enophthalmos as a prognostic factor in blow-out fracture of the orbit. Retrospective study of over 700 cases

The aim of the study was to determine the influence of posttraumatic enophthalmos in orbital blow-out fracture on the treatment results. The relationship between time from injury to treatment, type of surgical reconstruction, bone graft site, type of diplopia and treatment results were evaluated. The relationship between the location of the fracture and the degree of enophthalmos was also analyzed. The study included 730 patients, 128 women and 602 men, aged 4 to 77 years, average 28 years, treated because of orbital blow-out fracture in our Department between 1975 and 2015. The study included only patients with an isolated orbital floor or medial wall fracture, so-called "pure blow-out" or "internal blow- out". Fractures of the lower rim, roof or lateral wall of the orbit, as well as the coexistence of other fractures of the facial part of the skull, were excluding citeria from the study. Complete recovery in surgically treated patients was achieved in 405 (58.8%) patients, improvement in 179 (26%) and no improvement in 105 (15.2%) patients. The degree of post-traumatic enophthalmos affects the result of the treatment. The location of the orbital fracture affects the enophthalmos, in our group of patients the largest incidence occurred in the fracture located in the orbital floor combined with medial wall. Patients who underwent surgical treatment up to 14 days after the injury achieved better results than those postponed.

Reduction in visual acuity and intraocular injuries in orbital floor fracture

Blow-out fracture of the floor of the orbit is an increasingly recognized trauma. It may be an isolated injury, but because of various mechanisms may be also accompanied by the damage of other components of the visual system. The triad of clinical symptoms in blow-out fracture of the orbital floor includes: double vision, the enopthalmos and impaired sensation in the area of infraorbital nerve. Change of the position of the eyeball may lead to displacement and stretching of the optic nerve, which may result in the traumatic optic neuropathy. The aim of this paper is the evaluation of effectiveness of surgical and conservative tactics in the treatment of blow-out fracture of the floor of the orbit, accompanied by intraocular injuries, on the basis of retrospective study of the patients treated from 1971 to 2014.

MATERIAL AND METHODS

Based on a retrospective analysis of medical records of a group of 752 patients treated in our Department due to blow-out fracture of the orbit, during 44 years (1971-2015), intrabulbar injuries were found in 98 (13%) patients, and decrease in visual acuity was observed in 84 (11.2%) patients. In patients with decreased visual acuity values of sight acuity ranged from light perception to 0.8, in 3 patients the blow-out fracture of the orbit was accompanied by the superior orbital fissure syndrome, while in four patients orbital apex syndrome was observed. Statistical analysis of parameters of sight acuity before and after treatment was performed. The Wilcoxon test was used for dependent measurements (repeated), visual acuity after treatment was significantly higher than before. Due to the complexity of the injury, treatment of orbital floor fracture requires a multidisciplinary approach, in the team of maxillofacial surgeon, ophthalmologist, radiologist and neurologist.