Management of ocular dystopia and lacrimal pathway obstruction in old multiple midfacial fractures: Case report.

Midfacial fracture is discontinuity of the bone affect maxilla, palate, zygomatico-maxillary complex, nasal bones, orbits, nasal-orbital-ethmoid complex, and frontal sinus. Delayed treatment can lead to malunion or nonunion bone. A 28 years old man presented with epiphora of the left eye and upgaze diplopia. There were enophthalmos, hypoglobus of the left eye, flat nasal bridge, and depressed left malar eminence. CT scan examination revealed multiple fractures of left nasal bone, left and right anterolateral wall of maxillary sinuses, left medial orbital wall and orbital floor, and left zygomatic bone. Lacrimal irrigation test showed obstruction of left nasolacrimal duct. He underwent osteotomy and fixation with plate and screw, orbital floor reconstruction with silicone block implant, external dacryocystorhinostomy with silicone tube insertion procedure. In delayed treated malunion of midfacial fracture, fixation with plate and screw after refracture using an osteotome and orbital floor reconstruction with silicone block can be a good option for restoring normal anatomy. External dacryocystorhinostomy with silicone tube insertion is an effective treatment for post traumatic nasolacrimal duct obstruction.

Isolated Orbital Fractures Are Severe Among Geriatric Patients.

PURPOSE: The purpose of the present study was to clarify the reasons for, types of, and degree of involvement of the orbital wall and the severity of orbital fractures in geriatric patients and to compare the differences between geriatric and younger adult patients. MATERIALS AND METHODS: A retrospective case-control study of geriatric patients aged at least 65 years (n = 72) and younger controls aged 20 to 50 years (n = 58) with a diagnosis of a unilateral isolated orbital fracture was designed and implemented. The main exposure was age, the primary outcome was the isolated orbital fracture type, and the secondary outcomes were the associated orbital zones, fracture area (cm2), degree of dislocation (mm), involvement of anatomic landmarks, diplopia, altered ocular position, restricted eye movement, and ocular injuries. The confounding variables were gender, trauma mechanism, and alcohol abuse. The statistical methods included χ2 tests and logistic regression analyses. RESULTS: Among the geriatric patients, the great majority of isolated orbital fractures had been caused by falls (66.7%; P < .001). Geriatric orbital fractures were significantly more often extensive (2 cm2 or larger; P = .045) and associated with the middle-posterior orbital third (P = .032). In the logistic regression analyses, the elderly had a 2.2-fold greater risk of fractures of the middle-posterior orbital third and a 2.3-fold greater risk of extensive fractures compared with the younger controls. Ocular injuries were only diagnosed in the geriatric patients (5.6%). CONCLUSIONS: Falling is the most common mechanism of elderly orbital fractures. Isolated orbital fractures are extensive and mainly affect the globe supporting the middle and posterior parts of the orbital floor among geriatric patients.

The Paradoxical Predominance of Medial Wall Injuries in Blowout Fracture.

PURPOSE: To evaluate the type and cause of orbital blowout fractures in Korea. DESIGN: Retrospective, observational case series. METHODS: Patients who underwent reconstruction for blowout fracture from March 2004 to April 2013 at Korea University Guro and Ansan Hospitals were included in this study. Patient demographics and orbital computed tomography (CT) scans were reviewed. On CT, ethmoid air cell septa, blowout fracture type, and other combined fractures were analyzed. Blowout fracture was classified as affecting up to 4 areas: the floor lateral to the infraorbital canal, the floor medial to the canal, the maxilla-ethmoidal strut ("inferomedial" strut), and the medial wall. Furthermore, trauma type and associated injury were reviewed. The results of adolescent patients and adult patients were compared, as were those of males and females. RESULTS: The study included 659 eyes of 659 patients; mean patient age was 31.01 ±â€Š14.27 years. In total, 513 (77.85%) patients were male and 146 (22.15%) were female. The most common blowout fracture type was medial wall fracture, followed by floor wall, floor and medial wall without inferomedial strut, and floor and medial wall fracture with inferomedial strut, in that order. Interestingly, patients with floor wall blowout fracture were younger (26.87 ±â€Š12.90 y) than other groups: medial wall fracture (32.35 ±â€Š14.64 y, P < 0.0001), floor and medial wall fracture (35.22 ±â€Š14.49 y, P < 0.0001), and floor and medial wall fracture involving the maxillaethmoidal strut (32.62 ±â€Š13.75 y, P = 0.002). The number of ethmoidal air cell septa was lowest in the medial wall fracture group (3.62 ±â€Š0.67): floor wall fracture (4.07 ±â€Š0.69, P < 0.0001), floor and medial wall fracture (3.90 ±â€Š0.78, P < 0.0001), and floor and medial wall fracture involving the maxilla-ethmoidal strut (4.05 ±â€Š0.72, P = 0.001). CONCLUSIONS: Our study demonstrated that the blowout fracture type distribution in Korea varied from the results of many other studies. Medial wall fracture is the most common among the 4 types, and anatomic variance, such as number of ethmoid air cell septa, could influence blowout fracture type, especially in medial wall fracture.

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study.

OBJECTIVES: To assess the changing mid-face fracture patterns using a computed tomography scan. METHODOLOGY: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). CONCLUSION: With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

Management of pure orbital floor fractures: a proposed protocol to prevent unnecessary or early surgery.

PURPOSE: To present a case series review of management of pure orbital floor fractures and propose a protocol. METHODS: A retrospective review of medical records and computed tomography (CT) scan findings was completed. Fractures were classified into either trap-door, floor-fracture with incarcerated tissue, or depressed floor-fragment fractures. Criteria for surgical success were: enophthalmos <1mm; no hypoglobus/hyperglobus; extra-ocular muscle restriction <5° in upgaze but normal in all other positions on Hess chart; and no diplopia other than in extreme upgaze (5°). RESULTS: A total of 79 patients with orbital floor fractures were identified. There were 6 trap-door type fractures, 42 floor fractures with incarcerated tissue, and 31 depressed floor-fragment type fractures. Thirty-six patients were managed conservatively (antibiotics and observation). In nine of these, surgery was avoided by adhering to our protocol of delayed repair. Forty-three had surgical intervention: 6 were trap-door-type, 18 had a floor fracture with incarcerated tissue and 19 were of the depressed floor-fragment variety. All trap-door fractures underwent early repair (6/43, 14%), the rest had delayed repair (37/43, 84%). Four of 6 trap-door fractures had a successful outcome (66.6%). All 18 fractures with incarcerated tissue underwent successful delayed repair. Seventeen of 19 patients with depressed floor-fragment fractures were treated successfully surgically. The follow-up ranged from 12-64 months. The overall success rate was 85.3%. CONCLUSION: Non-trap-door type of floor fractures can have a successful outcome with delayed repair. This can avoid unnecessary surgery in selected cases. A management protocol is proposed.

Classification of orbital fractures using the AO/ASIF system in a population surveillance cohort of traumatic optic neuropathy.

PURPOSE: In our prospective nationwide surveillance study of traumatic optic neuropathy (TON) in the United Kingdom, the prevalence of orbital fractures was found to be 39% (47/121). The prevalence of skull fractures was 7.4% (9/121). This study aims to identify the association of craniofacial-orbital fractures with the severity of visual loss. METHODS: TON patients who sustained orbital fractures were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period. Available CT scans were classified by a head and neck radiologist according to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) scheme: the face was divided into 4 units; fractures in each unit were graded according to displacement (A-C) and severity (1.1-3.3). Correlation between severity of craniofacial orbital fractures and visual acuity as well as number of fractured units and visual acuity were evaluated. RESULTS: Twelve of the 25 patients (48%) with imaging available had adequate high resolution craniofacial CT imaging for review and classification using the AO/ASIF system (i.e. 48 classifiable units). Three of 48 (6%) units were undisplaced (grade A), 18 of 48 (29%) units were minimally displaced (grade B), and 4 of 48 (8%) units had largely displaced (grade C) fractures. Twenty-three units (47.9%) had no fractures; 5 patients had radiological evidence of optic canal fractures. Poor visual acuities positively correlated with severity of fractures graded using the AO/ASIF classification (Spearman's rho = 0.95, p = 0.05) and number of fractured units (Spearman's rho = 1.0, p < 0.0001). CONCLUSION: AO/ASIF classification system provides a uniform method in the assessment of orbital fractures which correlates with visual outcome in TON.

Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures.

PURPOSE: To determine the role of fracture size and soft tissue herniation as measured by computed tomography in predicting the development of persistent diplopia in patients with isolated orbital floor fractures. METHODS: A retrospective chart review identified patients presenting between March 2009 and 2012 with isolated orbital floor fractures. Computed tomographic scans were assessed for transverse fracture size and absence or presence of soft tissue herniation and rectus involvement. Presence of diplopia at 6-10 days, decision for surgical repair, and presence of diplopia were recorded. RESULTS: Fifty-six patients fulfilled inclusion criteria. Eighteen of 56 patients (32%) had preoperative diplopia. In Type A fractures, 0/9 (0%) small, 1/8 (12.5%) medium, and 2/14 (14%) large fractures had diplopia. For Type B fractures, 3/4 (75%) small, 9/13 (69%) medium, and 4/8 (50%) large fractures had diplopia. Type B fractures were significantly more likely to cause diplopia than Type A fractures in the small (p = 0.003) and medium (p = 0.007) size groups but not in the large groups (p = 0.07). CONCLUSION: Transverse fracture size and presence of soft tissue herniation on CT imaging can predict development of persistent diplopia in isolated orbital floor fractures. Small and medium sized fractures with soft tissue herniation are more likely to cause diplopia than large sized fractures. We recommend early repair or closer observation of small and medium sized orbital floor fractures with soft tissue herniation due to the high risk of diplopia.

Change of the orbital volume ratio in pure blow-out fractures depending on fracture location.

The purposes of this study were to observe bony orbital volume (OV) changes in pure blow-out fractures according to fracture location using a facial computed tomographic scan and to investigate whether the OV measurements can be used as a quantitative value for the evaluation of the surgical results of the acute blow-out fracture.Forty-five patients with unilateral pure blow-out fracture were divided into 3 groups: inferior (group I), inferior medial (group IM), and medial (group M) orbital wall fracture. The OV and the orbital volume ratio (OVR) were prospectively measured before and 6 months after surgery with the use of 3-dimensional computed tomographic scans, and the Hertel scale was measured with a Hertel exothalmometer.The preoperative OVR increased to the greatest extent in group IM, and the mean preoperative OVR was 121.46. The mean preoperative OVR in group I was significantly higher than that of group M (P = 0.005). The OV and OVR revealed a statistically significant decrease after the surgery (P = 0.000). The Hertel scale improved from -1.04 mm before the surgery to -0.78 mm after the surgery, but no significant difference was observed (P = 0.051).The OVR was useful as a quantitative value to evaluate pure blow-out fractures, compared with that of the Hertel scale. Fracture location-associated OVR studies are needed to make volume guidelines of blow-out fracture surgery.

[About the Geserick sign--a literature study]. / Uber das Geserick-Zeichen--eine Literaturstudie.

Fractures of the medial and basal orbital wall as well as the petrous part of the temporal bone were described first in 1980 by a Berlin-based study group led by Geserick as new cranium findings resulting from a contrecoup mechanism. Experimental and comparative examinations revealed that indirect fractures of the orbital walls are caused by a coup action of the eyeballs, whereas the mechanogenesis of the petrous bone fractures continues to be unclear. The frequently combined occurrence with the orbital sign nonetheless permits an allocation to the contrecoup mechanism. Both signs are important criteria for forensic and clinical assessment of craniocerebral injuries.

Functional outcome after surgical treatment of orbital floor fractures.

In the present article, the authors want to present the results of a retrospectively evaluated consecutive series of patients with surgically treated isolated orbital floor fractures (OFF; "blow-out fractures") concerning the functional outcome after OFF and give detailed recommendations based on the clinical and radiological findings. A series of 60 patients with isolated OFF over a 5-year period needing surgically repair at the same institution were evaluated. Patient data were analysed in terms of preoperative and postoperative clinical parameters and radiological findings. The analysed parameters were type of fracture, diplopia, gaze restriction, enophthalmos, materials used for repair, surgical approach and timing of the surgical intervention. Burst type fractures were more often found than punched-out fractures. The most frequently used surgical approach was a preseptal transconjunctival approach. An overall decrease of gaze restriction (93%), diplopia (89%) and enophthalmos (86%) was observed. According to the fracture size, we used Ethisorb patches in smaller fractures and resorbable or titanium meshes or autologous bone in larger fractures in most cases. Patients who underwent surgery more than 7 days after the trauma showed better results with regard to an improvement of diplopia and motility disturbances than patients who were treated immediately. In indicated cases, the surgical repair of OFF leads to very good results if the anatomical and functional properties of the orbit and its contents are respected. The applied strategy and means presented in our study proved of value and can therefore be recommended.

Correlation of types of orbital fracture and occurrence of enophthalmos.

We sought to investigate the correlation between type of orbital fracture and occurrence of traumatic enophthalmos. The 119 patients with orbital fractures were divided into the enophthalmos group (71 cases) and the nonenophthalmos group (48 cases). The 2 groups were compared by location and type of orbital fracture based on observation of computed tomography scans. We found the incidence of medial wall fractures significantly higher in the enophthalmos group (76.06%) than in the nonenophthalmos group (22.92%, χ(2) = 32.63, P < 0.05). The incidence of combined medial-inferior wall fractures was also significantly higher in the enophthalmos group (52.93%) than in the nonenophthalmos group (12.5%, χ(2) = 23.21, P < 0.05). However, the incidence of lateral-inferior wall fractures was significantly lower in the enophthalmos group (36.62%) than in the other group (58.33%, χ(2) = 4.11, P < 0.05). In most cases of lateral-inferior orbital wall fracture in the enophthalmos group, the zygomatic complex was displaced toward the lateral-posterior direction. The combined medial-inferior wall fracture is likely the primary type of multiple wall fracture leading to traumatic enophthalmos. Enophthalmos caused by a combined lateral-inferior fracture may be correlated with lateral-posterior displacement of the zygomatic complex.

Orbital floor reconstruction with resorbable polydioxanone implants.

Many different materials are proposed for reconstruction of traumatic orbital floor defects. Donor-site morbidity of autologous transplants and infections or extrusions of nonresorbable implants lead to a widespread use of resorbable, alloplastic materials such as polydioxanone (PDS). The goal of this study was to evaluate the prevalence of orbital floor fracture-related problems after surgical treatment using PDS. Ophthalmologic and clinical examinations were performed at 194 patients before orbital floor reconstruction, 14 days and 6 months after surgery (approximate defect sizes: <1 cm², n=50; 1-2 cm², n=97; >2 cm², n=47). Clinical findings including the ocular motility, the sensibility of the infraorbital nerve, and the position of the globe were evaluated. For statistical analysis of categorical data, confidence intervals of percentages were determined. Linear relationships between 2 variables were assessed with Pearson correlation analysis. A reduced ocular motility was diagnosed in 60 patients (31%) before surgery; in 14 patients (7%), 2 weeks; and in 10 patients (5%), 6 months after surgery. Infraorbital hypesthesia was found in 120 patients (62%) before surgery; in 47 patients (24%), 2 weeks; and in 35 patients (18%), 6 months after surgery. An enophthalmos was present in 10 patients (5%) before surgery, and in 4 patients (2%), 6 months after surgery. Our data suggest that PDS is a suitable implant for orbital floor reconstruction with acceptable low rates of infraorbital hypesthesia, bulbus motility disturbances, and enophthalmos. Polydioxanone can also be used for orbital floor defects exceeding 2 cm².

Orbital blowout fractures and race.

PURPOSE: To examine the type of orbital blowout fracture and its variation with race. DESIGN: Retrospective review of computed tomography (CT) scans and demography in an unselected cohort of patients with orbital blowout fractures. PARTICIPANTS: Patients with a high-resolution CT scan of adequate quality for analysis who presented with an orbital blowout fracture to the Orbital Clinic at Moorfields Eye Hospital. Patients with fractures involving the orbital rim or the cranium, or with penetrating injuries of the globe or orbit, were omitted from the study. METHODS: Demographic and ethnic information was collected for each patient, and the orbital scans were reviewed by a single observer. On the basis of coronal and axial imaging, a fracture was classified as affecting up to 4 areas: the floor lateral to the infraorbital canal (area 1, "A1"), the floor medial to the canal ("A2"), the maxillo-ethmoidal strut ("inferomedial" strut, "A3"), and the medial wall blowout fracture ("A4"); with fractures involving the inferomedial strut, it was noted whether there was displacement or rotation of the strut. Ethnic origin was classified as Caucasian, Afro-Caribbean, or Asian (Oriental or Indian). MAIN OUTCOME MEASURES: The proportion of different walls involved in orbital blowout fractures within 3 ethnic groups. RESULTS: A total of 152 patients (125 men, 82%) had imaging adequate for analysis; 103 (68%) were Caucasian, 19 (12%) were Afro-Caribbean, and 30 (20%) were Asian. Caucasians most commonly had floor fractures (A1 or A2 in 56 orbits, 54%) compared with 10 of 103 purely medial fractures (A4, 10%); in contrast, medial fractures were the most common type in Afro-Caribbean patients (7/19 cases, 37%), and purely floor fractures occurred in only 2 cases (10%) (P<0.005). Asian patients had results similar to those for Caucasian patients, with isolated floor fractures being the most common (14/30 cases, 47%). CONCLUSIONS: Most blowout fractures involve the orbital floor in Caucasian and Asians, whereas in Afro-Caribbeans the most common site for fracture is the medial wall. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Reconstruction of severe medial orbital wall fractures using titanium mesh plates placed using transcaruncular-transconjunctival approach: a successful combination of 2 techniques.

PURPOSE: To prospectively evaluate the use of titanium mesh plates in a combined transcaruncular-transconjunctival approach for severe medial orbital wall fractures. PATIENTS AND METHODS: We analyzed the clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. The fracture location was the medial wall in 5 (50%) and the floor/medial wall in 5 (50%). Of the 10 patients, 8 (80%) were treated using 3-dimensionally preformed orbital titanium mesh plates and 2 (20%) with nonpreformed radial orbital mesh plates fixed at the inferior orbital rim with 1 or 2 monocortical screws (diameter 1.3 mm). RESULTS: All the patients had satisfactory and anatomically correct orbital wall reconstruction as assessed on the immediate postoperative computed tomography scan. None of the patients experienced ophthalmic complications related to the transcaruncular-transconjunctival approach or developed enophthalmos as determined using Hertel exophthalmometry. One patient (10%) developed a nonhandicapping diplopia related to post-traumatic muscular contusion of the medial rectus muscle. CONCLUSIONS: The present study has demonstrated that titanium mesh plates placed using a combined transcaruncular-transconjunctival approach for the reconstruction of severe medial orbital wall fractures results in a high rate of success.

Repair of blowout orbital floor fracture by periosteal suturing.

The study objective was to evaluate the outcome of a periosteal suturing technique in eyes with orbital blowout fractures. Fifteen orbital floor fractures were classified into: type 1, linear fracture; type 2, middle fracture; and type 3, posterior fracture extending two-thirds into the orbit. The feasibility of periosteal suturing without silicone plates or one of minimal size was determined. The improvement of ocular movements and surgical complications were evaluated. A complete suture of the torn periosteum without implanting a silicone plate was achieved in 2/2 (100%) type 1 cases, 5/7 (71%) type 2 cases and 0/6 (0%) type 3 cases. A partial fixation was achieved in 3/6 (50%) type 3 cases with an implantation of a silicone plate of approximate one-third of the usual size in one case. Conventional surgery with silicone plates after failed periosteal suture was required in 2/7 (29%) type 2 cases and 3/6 (50%) type 3 cases. Eye movements were improved postoperatively in all eyes, and a complete range of eye movements was achieved in 6/7 (86%) cases with complete periosteal closure, 1/3 (33%) of cases with partial closure and 2/5 (40%) cases without closure. In conclusion, periosteal suturing can minimize the need for silicone plates especially for anterior or middle orbital floor factures.

Pediatric orbital fractures.

The clinical presentation and management of pediatric orbital fractures have many unique features that differentiate them from orbital injuries encountered in the adult population. An understanding of the particular anatomic and mechanical properties of pediatric orbital bone and soft tissue helps to explain most of these differences. This article reviews the epidemiology, anatomy, growth implications, pathomechanics, particular clinical features, assessment, and surgical management of pediatric orbital fractures.

Pediatric nasoorbitoethmoid fractures.

The pediatric craniofacial trauma literature largely focuses on the management of mandible fractures, with very little information focusing on pediatric midface fractures, specifically nasoorbitethmoid (NOE) fractures. Because the diagnosis and surgical treatment plan for adult NOE fractures is well established in the literature, the treatment algorithms for NOE are essentially a transfer of adult practices to pediatric patients. This article reviews the differences between the pediatric and adult facial skeleton and the pathology and presentation of NOE fractures in the pediatric craniomaxillofacial skeleton. It also presents the effects of NOE fractures on the growth and development of the pediatric facial skeleton and describes the current surgical management for NOE fractures.

Analysis of complications after surgical repair of orbital fractures.

BACKGROUND: The term "orbital blow-out fracture" is referred to as the mechanism by which an impact to the eyeball is transposed as a mechanical energy to the orbital walls, causing them to fracture. Despite a proper surgical technique, a successful anatomic reconstruction of the orbit, and an accurate follow-up, 3 complications are still frequently observed at long-term follow-up: diplopia, enophthalmos, and hypesthesia of the infraorbital nerve territory. In this retrospective study, we analyze the incidence, the specific characterization, and the potential risk factors of these 3 complications. METHODS: The records of 75 patients who underwent surgical repair of isolated orbital blow-out fracture from January 2001 to December 2007 at the Maxillofacial Surgery Unit of the Novara Major Hospital were reviewed retrospectively. Patients who had other coexisting facial fractures or orbital rim involvement were excluded from this study. The mean follow-up reached 39 months (range, 6-81 months). Enophthalmos was measured by a Hertel exophthalmometer; diplopia was evaluated by an optometrist with cover test, red glass test, and Hess-Lancaster test; and hypesthesia of the infraorbital nerve territory was checked by clinical examination. The studied parameters included patient's age and sex, time interval between trauma and surgery, location of the fracture, and implant material. The χ test for nonparametric data was used, and a P value of less than 0.05 was considered statistically significant. RESULTS: Sex, location of the fracture, and implant material were not considered statistically significant (P > 0.05). The unique variable that influenced our data was the time interval between trauma and surgery (P > 0.05). DISCUSSION: Although the surgical technique was executed properly and the immediate postoperative recovery was uneventful, diplopia, enophthalmos, and infraorbital nerve dysfunction were the frequent complications. We stress the fact that orbital blow-out fracture is generally not considered a technically demanding procedure, but the outcome can be very disappointing; the surgical procedure must be managed very carefully by experienced surgeons to lower the high rates of these 3 common complications. However, we can report that the incidence of diplopia, enophthalmos, and infraorbital nerve dysfunction are decreased by an immediate intervention and an early surgical repair of the orbital blow-out fracture. Patients who had surgery within 2 weeks of trauma have a lower risk to develop postoperative complications; this study supports an early surgical treatment of orbital blow-out fractures, when it is indicated.

Comparison of the outcomes of non-trapdoor-type blowout fracture repair according to the time of surgery.

PURPOSE: We classified the outcomes of non-trapdoor-type blowout fracture repair by surgical indications and then compared the outcomes according to the time of treatment. METHODS: The medical records of 591 patients with orbital fractures that were treated surgically within 30 days of trauma were included in the study. The enrolled patients were classified into 2 groups by the major surgical indications: 1 group included patients with diplopia or limited extraocular motion, and the other group of patients had significant enophthalmos (>2 mm) or a large fracture on computed tomography (>½). The clinical outcomes were compared between the patients who received surgical repair within 14 days of trauma (early) and those who received treatment from 15 to 30 days after the trauma (delayed) in each group. RESULTS: Two hundred thirty-three patients received surgical repair because of diplopia or limited extraocular motion. Both the early repaired group (n = 195) and the delayed repaired group (n = 38) showed significant improvement after surgeries. The degree of preoperative and postoperative diplopia and limited extraocular motion was not associated with differences between the 2 groups. Four hundred one patients received surgical repair because of enophthalmos (>2 mm) or a large fracture on computed tomography (>½). Both the early repaired group (n = 328) and the delayed repaired group (n = 73) showed significant improvement of the enophthalmos after surgeries. The degree of preoperative/postoperative enophthalmos did not show differences between the 2 groups. CONCLUSIONS: If the blowout fracture repairs were performed within a month, the surgical outcomes did not differ according to the time of surgery in the cases of nontrapdoor blowout fracture.

Fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer.

OBJECTIVE: The objective of the study was to compare the functional and aesthetic results of fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer. MATERIALS AND METHODS: Twenty patients with blow-out orbital fracture/orbital floor associated or not with the medial wall were assessed by the same craniofacial surgical group. All were evaluated preoperatively and postoperatively by an ophthalmologist for diplopia, enophthalmos, exophthalmos, sensitivity, ophthalmic reflexes, intraocular pressure, and visual field.The patients were subjected to a preoperative facial multislice computed tomographic scan, repeated 6 months after surgery. Eight patients underwent reconstruction with an auricular cartilage graft, and 12 patients, with blade absorbable polyacid copolymer. Subtarsal access was used for all patients. RESULTS: Two patients showed temporary ectropion, 1 in each group. All patients presented satisfactory ocular function, and all tests revealed good orbital delineation, orbital symmetry, periorbital sinus individualization, and reduction of blow-out. CONCLUSIONS: The blow-out orbital wall reconstruction can be performed with the use of an auricular cartilage or with a blade absorbable copolymer without differences regarding functional or aesthetic complications and sequelae.