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Indications for surgical repair of isolated medial orbital wall fractures: A systematic review
Michael Wells, M.Eng, Irene Chang, BA, Anand R. Kumar, MD, Edward H. Davidson, MD
University Hospitals, Case Western School of Medicine
2020-02-08
Presenter: Michael Wells
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Anand Kumar
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
There are few established criteria for surgical repair of isolated medial orbital wall fractures. While muscle entrapment and acute globe malposition are absolute indications for repair, identifying patients at risk for delayed enophthalmos and requiring surgery remains a challenge.
Method:
PubMed, Embase, and Web-of-Science databases were queried for medial orbital wall fracture studies. All data was screened and extracted by two investigators and relevant English-language primary-literature was analyzed. Information on sample size, intervention (surgical vs non surgical), indications for intervention, and timing of intervention was obtained.
Results:
Initial search provided 1791 studies, with 204 subject to full article review. In 84 studies explored, 2038 patients were treated for a total of 2040 orbits. Acute enophthalmos (20% studies, with 9.5% specifying > 2mm and 3.6% specifying the timeframe) and medial rectus entrapment/limited eye movement (14%) were confirmed as absolute indications for surgery. In absence of which, 14% studies cited diplopia (4.8% specifying timeframe), 6% studies quoted fracture displacement (2.4% specifying 3mm and 1.2% with 2mm as the minimum), 7.1% studies cited area of fracture (range 0.55 to 2.75 cm2), 2.5% studies cited volume of herniated tissue, and 2.4% studies examined height to width ratio of medial rectus muscle as indicators for surgery. No studies explored location of the fracture.
Conclusion:
There is no consensus on medial wall fracture patterns that correlate with development of enophthalmos nor indication for surgery. The relative importance of fracture size, location and degree of fascioligamentous sling disruption must be determined to establish clinical guidelines.
