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Surgical Management of Orbit Fractures and Their Complications
Danielle C. Marshall, BA, Kyle M. Lineberry, MD, John D. Marshall, BA, Ali Totonchi, MD
Case Western Reserve University
2018-01-31
Presenter: Danielle Marshall
Affidavit:
Danielle Marshall
Director Name: Ali Totonchi
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: Surgical management of orbit fractures and complications is widely debated. We examined presenting characteristics of orbit fractures, compared the complication rate of repair materials and incision techniques and characterized the management of these postoperative complications.
METHODS: A retrospective review was performed on all patients diagnosed with orbit fracture presenting to a level I trauma hospital from 2004-2016. Demographics, operative technique and management of complications were analyzed.
RESULTS: A total of 162 orbit fractures met inclusion criteria. Mechanism of trauma was significantly associated with location of orbit fracture and concomitant injuries. Floor fractures were most common after motor vehicle accidents and roof fractures after gunshot injuries. Patients who underwent repair with titanium mesh implants were significantly more likely to have incomplete resolution of preoperative enophthalmos (p = 0.007) and undergo reoperation (p = 0.019) compared to those that received porous polyethylene. Subciliary incision was associated with increased resolution of preoperative enophthalmos compared with transconjunctival incision (p = 0.002) and no increased risk of residual ectropion or reoperation. The most common complications postoperatively were reduced sensation in V2 distribution (15.85%) and enophthalmos (10.97%).
CONCLUSION: The study results demonstrate that the use of porous polyethylene is safe and potentially superior to the use of titanium mesh implants for orbit fracture repair. Our data also demonstrates that the subciliary approach can be safely used with no increased risk of ectropion or reoperation. It is recommended that surgical management be based on mechanism of injury and presenting symptoms rather than risk of postoperative complications.
