Journal of Plastic, Reconstructive & Aesthetic Surgery
Predicting late enophthalmos: Differences between medial and inferior orbital wall fractures
Introduction
Orbital wall fractures can lead to several complications such as diplopia, enophthalmos, or limited extraocular movement. When noticeable enophthalmos or diplopia caused by incarceration of the extraocular muscle or fine ligament system is observed, surgical intervention should be considered. However, enophthalmos is usually not immediately apparent because of edema of the orbital tissues. Thus, many surgeons have estimated the extent of late enophthalmos based mainly on the size of orbital wall defects calculated using computed tomographic (CT) images. Therefore, there have been many studies on the expected defect size associated with enophthalmos in orbital wall fractures.1, 2, 3, 4, 5, 6, 7 However, defect size varies between papers or locations of fracture, and there has been little research on isolated orbital wall fracture rather than multiple wall orbital fractures.
Several papers have reported that the volume of herniated orbital tissue or morphologic change in extraocular muscles can be a predictor of late enophthalmos in orbital wall fractures.2, 3, 4, 8, 9 However, to our knowledge, there are no reports comparing the strengths of the relationships between these predictors and late enophthalmos. In medial and inferior orbital wall fractures, orbital tissue herniates into the anatomically distinct ethmoid and maxillary sinuses.10 Thus, there can be a major difference in predictors of late enophthalmos between medial and inferior orbital wall fractures. Therefore, the purpose of this study is to compare several predictors of late enophthalmos in medial and inferior orbital wall fractures and to determine the most significant predictive factor of enophthalmos in medial or inferior orbital wall fracture.
Section snippets
Materials and methods
This study was a retrospective review of consecutive adult patients who were diagnosed with unilateral medial or inferior orbital wall fracture during a nine-year period from January 2004 to December 2012. No patient underwent reconstruction of orbital wall fracture for more than two months after the original injury. This study was conducted after obtaining approval from the Institutional Review Board of Sungkyunkwan University (2013-SCMC-031-00). Only patients with complete clinical records,
Results
Sixty-three patients were included in this study and were divided into two groups: medial and inferior orbital wall fracture groups. The mean age was 27.9 ± 13.9 years in the medial orbital wall fracture group and 27.9 ± 12.0 years in the inferior orbital wall fracture group (p = 0.986). The medial orbital wall fracture group consisted of 23 men and 10 women, and the inferior orbital wall fracture group consisted of 22 men and eight women (p = 0.750). The mean follow-up period was
Discussion
In the medial orbital wall fracture group, symmetric displacement of the fractured orbital bone commonly occurs because of the cellular structure of the ethmoid bone.2, 16 The symmetric displacement results in a hemi-elliptical herniation of the orbital soft tissue (Figure 3, left), which indicates an increase in orbital volume in proportion to the size of the orbital wall defect. In our results, herniated muscle and fat volume were positively correlated with defect area in medial orbital wall
Conclusions
In an actual clinical setting, most surgeons measure orbital defect size using CT scanning in order to estimate the degree of late enophthalmos and determine the necessity for surgical treatment. However, in our study, defect area was significant as a predictor of late enophthalmos in medial orbital wall fractures but not in inferior orbital wall fractures. Herniated fat volume was a predictor of late enophthalmos only in inferior orbital wall fractures. Therefore, use of defect size for
Conflict of interest statement
None.
Acknowledgements
This research was supported by the Bisa Research Grant of Keimyung University in 2014.
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- d
Contributed equally to this paper as first authors.