Challenges and considerations of orbital floor fracture: Report of two cases with and without surgical treatment
Nikolaos KOLOMVOS, Anastassios I. MYLONAS, Lampros GOUTZANIS, Nadia THEOLOGIE-LYGIDAKIS
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece (Head: Professor C. Perisanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 1, 1-9
SUMMARY: The orbital floor is a relatively common anatomical area of injury and its fracture is mainly the re- sult of road traffic accidents and interpersonal violence. The most common post-traumatic finding is the entrapment of the inferior rectus and/or the inferior oblique extraocular muscle in the fracture line, leading to a decrease in the motility of the ipsilateral globe, diplopia, and late enophthalmos or hypophthalmos. Therapeutic management is based on both clinical examination and radiographic findings, whereas ophthalmic examination is also necessary. Reconstruction is usually done by surgery, providing satisfactory results if performed on time. If the fracture is left untreated due to ophthalmological problems or other accompanying injuries, diplopia may remain or even enophthalmos.
The objective of the present report is to study the development of complications and the possible way to treat them, with or without surgical intervention, in two patients.
KEY WORDS: Orbital floor fracture, enophthalmos, diplopia, therapeutic management.
REFERENCES
Αγγελόπουλος Α, Αλεξανδρίδης Κ, Κατσικέρης Ν: Στοματική και Γνα- θοπροσωπική Χειρουργική. Β΄ Τόμος, Εκδόσεις Λίτσας, Σελ. 527– 533, Αθήνα, 2008
Bansagi ZC, Meyer DR: Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology, 107:829-36, 2000
Βαϊρακτάρης Ε, Schwenzer N, Neukam FW: Γναθοπροσωπική Χει- ρουργική. Τόμος Ι, Εκδόσεις Π.Χ. Πασχαλίδης, Αθήνα 2005
Brady SM, McMann MA, Mazzoli RA, Bushley DM, Ainbinder DJ, Carrol RB: The diagnosis and management of orbital blowout fractures: update 2001. Am J Emergency Medicine, 19(2): 147–154, 2001
Bruce M, Ghosh A: Antibiotics in orbital floor fractures. Journal of Emergency Medicine (EMJ), 20 (1): 66, 2003
Βurnstine MA: Clinical recommendations for repair of orbital facial fractures. Go Curr Opin Opthalmol. 14(5): 236-40, 2003
Caranci F, Cicala D, Cappabianca S, Briganti F, Brunese L, Fonio P: Or- bital fractures: Role of imaging. Semin Ultrasound CT MRI, 33 (5): 385–91, 2012
Cat Nguyen Burkat: Orbital Floor Fractures. Amer. acad. of ophthalmology, 2017
Catone GA, Morrissette MP, Carlson ER: A retrospective study of untreated orbital blow-out fractures. J Oral Maxillofac Surg. 46 (12): 1033 –1037, 1988
Courtne DJ, Thomas S, Whitfield PH: Isolated orbital blowout frac- tures: survey and review. Br J Oral Maxillofacial Surg, 38 (5): 496- 504, 2000
De Man K, Wijngaarde R, Hes J, De Long PT: Influence of age on the management of blow-out fractures of the orbital floor. Int J Oral Maxillofac Surg, 20: 330-6, 1991
Dulley B, Fells P: Long-term follow-up of orbital floor blow-out with and without surgery. Mod Probl Ophthalmol. 14:467-70, 1975
Ellis E: Orbital trauma. J Oral Maxillofac Surg, 24 (4): 629–48, 2012 Emery J, Noorden GK, Schlernitzauer DA: Orbital floor fractures: Long-
term follow-up of cases with and without surgical repair. Tr Am Acad Ophthalmol Otolanyngol. 75: 802–11, 1971
Folkestad L, Granstrom G: A prospective study of orbital fracture sequelae after change of surgical routines. J Oral Maxillofac Surg. 61: 1038–44, 2003
Gosau M, Schoneich M, Draenert FG, Ettl T, Driemel O, Reichert TE: Retrospective analysis of orbital floor fractures-complications, out- come and review of literature. Clin Oral Investig. 15(3): 305-13, 2011
Gunarajah DR, Samman N: Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg. 71 (6): 1151-4, 2013
Hatton MP, Watkins LM, Rubin PA: Orbital fractures in children. Oph- thalmic Plastic and Reconstructive Surgery 17 (3): 174–179, 2001 Iatrou I, Theologie-Lygidakis N, Angelopoulos A: Use of different grafts in the reconstruction of orbital fractures. Clinical experience from
55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 91: 281-6, 2001
Jamal BT, Pfahler SM, Lane KA, Bilyk JR, Pribitkin EA, Diecidue RJ, Taub DI: Ophthalmic Injuries in Patients With Zygomatico-maxillary Complex Fractures. J Oral and Maxillfac Surg. 67(5): 986-989, 2009
Kernich CA: Diplopia. The Neurologist, 12 (4): 229-230, 2006
Kim BB, Qaqish C, Frangos J, Caccamese JF: Oculocardiac reflex in- duced by an orbital floor fracture: report of a case and review of the literature. J Oral Maxillofac Surg. 70(11): 2614-9, 2012
Krasadakis C, Igoumenakis D, Schoinohoriti O, Mourouzis C, Rallis G: The significance of orbital floor exploration during open re- duction of zygomaticomaxillary complex fractures. JRPMS, 1(2):45-49, 2017
Lederman IR: Loss of vision associated with surgical treatment of zy- gomatic-orbital floor fracture. Plast Reconstr Surg. 68: 94–9, 1981 Leitch RJ, Burke JP, Stracham IM: Orbital blow-out fractures – the in- fluence of age on surgical outcome. Acta Ophthalmol, 68: 118-
24, 1990
Losee JE, Afifi A, Jiang S et al.: Pediatric orbital fractures: Classification, management and early follow-up. Plast Reconstr Surg. 122: 886– 97, 2008
Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L: Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg, 13 (6): 726–738, 2002
Matteini C, Renzi G, Becelli R, Belli E, Iannetti G: Surgical timing in or- bital fracture treatment: experience with 108 consecutive cases. J Craniofac Surg, 15: 145-50, 2004
Merali FI, Grant MP, Mahoney NR: Orbital Floor Fracture with Atypical Extraocular Muscle Entrapment Pattern and Intraoperative Asys- tole in an Adult. Craniomaxillofac Trauma Reconstr. 8 (4): 370- 4, 2015
Ng P, Chu C, Young N, Soo M: Imaging of orbital floor fractures. Aus- tralasian Radiology. 40 (3): 264–268, 1996
Premalatha Shetty G, Senthil Kumar, Mohan Baliga, Nakul U: Options in orbital floor reconstruction in blowout fractures: a review of ten cases. J Maxillofac Oral Surg., 8 (2): 137–140, 2009
Putterman AM, Stevens T, Urist MJ: Nonsurgical management of blow-out fractures of the orbital floor. Am J Ophthalmol, 77: 232–9, 1974 Pάλλης Γ, Παπαδάκης Δ, Παπακώστα Β, Βαλλιανάτου Δ, Ζαχαριάδης Ν: Κλινική εμπειρία από τη χρήση του πορώδους πολυαιθυλενίου (Medpor) στην κρανιοπροσωπική χώρα. Αρχ. Ελλ. Στομ. Γναθ.
Χειρ., 5(2): 63-68, 2004
Salgarelli AC, Bellini P, Landini B, Multinu A, Consolo U: A comparative study of different approaches in the treatment of orbital trauma: An experience based on 274 cases. Oral Maxillofac Surg. 14:23– 7, 2010
Smith B, Regan WF: Blow-out fracture of the orbit; mechanism and correction of internal orbital fracture. Am J Ophthalmol, 44: 733– 9, 1957
Tang DT, Lalonde JF, Lalonde DH: Delayed immediate surgery for or- bital floor fractures: Less can be more. Can J Plast Surg. 19(4): 125–128, 2011
Theologie - Lygidakis N, Iatrou I, Alexandridis C: Blow-out fractures in children: six years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103: 757-63, 2007
Wang S, Xiao J, Liu L, Lin Y, Li X, Tang W, Wang H, Long J, Zheng X, Tian W: Orbital floor reconstruction: a retrospective study of 21 cases. Oral Surg. Oral Med. Oral Pathol. Oral Radiol Endod., 106(3): 324-30, 2008
Wilde F, Lorenz K, Ebner AK, Krauss O, Mascha F, Schramm A: Intra-operative imaging with a 3D C-arm system after zygomatico-or- bital complex fracture reduction. J Oral Maxillofac Surg. 71 (5): 894–910, 2013
Yilmaz M, Vayvada H, Aydin E, Menderes A, Atabey A: Repair of fractures of the orbital floor with porous polyethylene implants. Br J Oral Maxillofac Surg. 45: 640–4, 2007
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece (Head: Professor C. Perisanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2020) 1, 1-9
SUMMARY: The orbital floor is a relatively common anatomical area of injury and its fracture is mainly the re- sult of road traffic accidents and interpersonal violence. The most common post-traumatic finding is the entrapment of the inferior rectus and/or the inferior oblique extraocular muscle in the fracture line, leading to a decrease in the motility of the ipsilateral globe, diplopia, and late enophthalmos or hypophthalmos. Therapeutic management is based on both clinical examination and radiographic findings, whereas ophthalmic examination is also necessary. Reconstruction is usually done by surgery, providing satisfactory results if performed on time. If the fracture is left untreated due to ophthalmological problems or other accompanying injuries, diplopia may remain or even enophthalmos.
The objective of the present report is to study the development of complications and the possible way to treat them, with or without surgical intervention, in two patients.
KEY WORDS: Orbital floor fracture, enophthalmos, diplopia, therapeutic management.
REFERENCES
Αγγελόπουλος Α, Αλεξανδρίδης Κ, Κατσικέρης Ν: Στοματική και Γνα- θοπροσωπική Χειρουργική. Β΄ Τόμος, Εκδόσεις Λίτσας, Σελ. 527– 533, Αθήνα, 2008
Bansagi ZC, Meyer DR: Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology, 107:829-36, 2000
Βαϊρακτάρης Ε, Schwenzer N, Neukam FW: Γναθοπροσωπική Χει- ρουργική. Τόμος Ι, Εκδόσεις Π.Χ. Πασχαλίδης, Αθήνα 2005
Brady SM, McMann MA, Mazzoli RA, Bushley DM, Ainbinder DJ, Carrol RB: The diagnosis and management of orbital blowout fractures: update 2001. Am J Emergency Medicine, 19(2): 147–154, 2001
Bruce M, Ghosh A: Antibiotics in orbital floor fractures. Journal of Emergency Medicine (EMJ), 20 (1): 66, 2003
Βurnstine MA: Clinical recommendations for repair of orbital facial fractures. Go Curr Opin Opthalmol. 14(5): 236-40, 2003
Caranci F, Cicala D, Cappabianca S, Briganti F, Brunese L, Fonio P: Or- bital fractures: Role of imaging. Semin Ultrasound CT MRI, 33 (5): 385–91, 2012
Cat Nguyen Burkat: Orbital Floor Fractures. Amer. acad. of ophthalmology, 2017
Catone GA, Morrissette MP, Carlson ER: A retrospective study of untreated orbital blow-out fractures. J Oral Maxillofac Surg. 46 (12): 1033 –1037, 1988
Courtne DJ, Thomas S, Whitfield PH: Isolated orbital blowout frac- tures: survey and review. Br J Oral Maxillofacial Surg, 38 (5): 496- 504, 2000
De Man K, Wijngaarde R, Hes J, De Long PT: Influence of age on the management of blow-out fractures of the orbital floor. Int J Oral Maxillofac Surg, 20: 330-6, 1991
Dulley B, Fells P: Long-term follow-up of orbital floor blow-out with and without surgery. Mod Probl Ophthalmol. 14:467-70, 1975
Ellis E: Orbital trauma. J Oral Maxillofac Surg, 24 (4): 629–48, 2012 Emery J, Noorden GK, Schlernitzauer DA: Orbital floor fractures: Long-
term follow-up of cases with and without surgical repair. Tr Am Acad Ophthalmol Otolanyngol. 75: 802–11, 1971
Folkestad L, Granstrom G: A prospective study of orbital fracture sequelae after change of surgical routines. J Oral Maxillofac Surg. 61: 1038–44, 2003
Gosau M, Schoneich M, Draenert FG, Ettl T, Driemel O, Reichert TE: Retrospective analysis of orbital floor fractures-complications, out- come and review of literature. Clin Oral Investig. 15(3): 305-13, 2011
Gunarajah DR, Samman N: Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg. 71 (6): 1151-4, 2013
Hatton MP, Watkins LM, Rubin PA: Orbital fractures in children. Oph- thalmic Plastic and Reconstructive Surgery 17 (3): 174–179, 2001 Iatrou I, Theologie-Lygidakis N, Angelopoulos A: Use of different grafts in the reconstruction of orbital fractures. Clinical experience from
55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 91: 281-6, 2001
Jamal BT, Pfahler SM, Lane KA, Bilyk JR, Pribitkin EA, Diecidue RJ, Taub DI: Ophthalmic Injuries in Patients With Zygomatico-maxillary Complex Fractures. J Oral and Maxillfac Surg. 67(5): 986-989, 2009
Kernich CA: Diplopia. The Neurologist, 12 (4): 229-230, 2006
Kim BB, Qaqish C, Frangos J, Caccamese JF: Oculocardiac reflex in- duced by an orbital floor fracture: report of a case and review of the literature. J Oral Maxillofac Surg. 70(11): 2614-9, 2012
Krasadakis C, Igoumenakis D, Schoinohoriti O, Mourouzis C, Rallis G: The significance of orbital floor exploration during open re- duction of zygomaticomaxillary complex fractures. JRPMS, 1(2):45-49, 2017
Lederman IR: Loss of vision associated with surgical treatment of zy- gomatic-orbital floor fracture. Plast Reconstr Surg. 68: 94–9, 1981 Leitch RJ, Burke JP, Stracham IM: Orbital blow-out fractures – the in- fluence of age on surgical outcome. Acta Ophthalmol, 68: 118-
24, 1990
Losee JE, Afifi A, Jiang S et al.: Pediatric orbital fractures: Classification, management and early follow-up. Plast Reconstr Surg. 122: 886– 97, 2008
Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L: Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions. J Craniofac Surg, 13 (6): 726–738, 2002
Matteini C, Renzi G, Becelli R, Belli E, Iannetti G: Surgical timing in or- bital fracture treatment: experience with 108 consecutive cases. J Craniofac Surg, 15: 145-50, 2004
Merali FI, Grant MP, Mahoney NR: Orbital Floor Fracture with Atypical Extraocular Muscle Entrapment Pattern and Intraoperative Asys- tole in an Adult. Craniomaxillofac Trauma Reconstr. 8 (4): 370- 4, 2015
Ng P, Chu C, Young N, Soo M: Imaging of orbital floor fractures. Aus- tralasian Radiology. 40 (3): 264–268, 1996
Premalatha Shetty G, Senthil Kumar, Mohan Baliga, Nakul U: Options in orbital floor reconstruction in blowout fractures: a review of ten cases. J Maxillofac Oral Surg., 8 (2): 137–140, 2009
Putterman AM, Stevens T, Urist MJ: Nonsurgical management of blow-out fractures of the orbital floor. Am J Ophthalmol, 77: 232–9, 1974 Pάλλης Γ, Παπαδάκης Δ, Παπακώστα Β, Βαλλιανάτου Δ, Ζαχαριάδης Ν: Κλινική εμπειρία από τη χρήση του πορώδους πολυαιθυλενίου (Medpor) στην κρανιοπροσωπική χώρα. Αρχ. Ελλ. Στομ. Γναθ.
Χειρ., 5(2): 63-68, 2004
Salgarelli AC, Bellini P, Landini B, Multinu A, Consolo U: A comparative study of different approaches in the treatment of orbital trauma: An experience based on 274 cases. Oral Maxillofac Surg. 14:23– 7, 2010
Smith B, Regan WF: Blow-out fracture of the orbit; mechanism and correction of internal orbital fracture. Am J Ophthalmol, 44: 733– 9, 1957
Tang DT, Lalonde JF, Lalonde DH: Delayed immediate surgery for or- bital floor fractures: Less can be more. Can J Plast Surg. 19(4): 125–128, 2011
Theologie - Lygidakis N, Iatrou I, Alexandridis C: Blow-out fractures in children: six years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103: 757-63, 2007
Wang S, Xiao J, Liu L, Lin Y, Li X, Tang W, Wang H, Long J, Zheng X, Tian W: Orbital floor reconstruction: a retrospective study of 21 cases. Oral Surg. Oral Med. Oral Pathol. Oral Radiol Endod., 106(3): 324-30, 2008
Wilde F, Lorenz K, Ebner AK, Krauss O, Mascha F, Schramm A: Intra-operative imaging with a 3D C-arm system after zygomatico-or- bital complex fracture reduction. J Oral Maxillofac Surg. 71 (5): 894–910, 2013
Yilmaz M, Vayvada H, Aydin E, Menderes A, Atabey A: Repair of fractures of the orbital floor with porous polyethylene implants. Br J Oral Maxillofac Surg. 45: 640–4, 2007
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