Orbital floor fractures: a retrospective review of 45 cases at a tertiary health care center

Abstract

The purpose of this retrospective study was to investigate treatment options for orbital floor fractures at a Level 1 Trauma Center in Southern California. A review of 45 cases of isolated orbital floor fractures treated at the University of California at Irvine between February 2004 and April 2007 was done. Patients were retrospectively analyzed for gender, age, mechanism of injury, associated facial injuries, presenting symptoms, method of treatment, and postoperative complications. Thirty-six male patients and nine female patients were treated. Motor vehicle collision (26/45) was the most common cause of injury, and the mean age of the patients was 35.5 years (range: 15-81 years). Ecchymosis surrounding the orbital tissue was the most common presentation (38/45). Diplopia was present in 8 of 45 patients, with 1 patient requiring urgent decompression for retrobulbar hematoma. Forty-three patients underwent surgical repair; 40 underwent transconjunctival approach with lateral canthotomy; 17 underwent reconstruction with porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA.); and 26 underwent reconstruction with a titanium mesh plate. Immediate postoperative complications included 12 patients with infraorbital numbness, 3 with diplopia, 1 with cellulitis, and 1 with ectropion with a subcilliary approach. Average timing of surgery of our study was 4.94 days (range, 1-20 days). Orbital floor fracture management has changed significantly over the past few decades with the introduction of new internal fixation methods and new materials for reconstructing orbital floor defects. Recommendations for surgical intervention on orbital floor fractures mostly depend on clinical examination and imaging studies. Consequences of inadequate repair of orbital floor fractures can lead to significant facial asymmetry and visual problems. Both porous polyethylene and titanium plates are effective tools for reconstructing the orbital floor. Our review demonstrates that orbital floor fractures can be repaired safely with minimal postoperative complications and confirms that transconjunctival approach to orbital floor is an effective way for exposure and prevention of ectropion that can be seen with other techniques.

Keywords: Orbital floor fractures; review; treatment options.

Figure 1

Bones of the orbit.

Figure 2

Cross-sectional anatomy of the lower eyelid.

Figure 3

Transconjunctival surgical approaches to the inferior orbit. The solid line represents the preseptal approach, and the dashed line represents the postseptal approach.

Figure 4

Subciliary surgical approach to the inferior orbit. The solid line represents a skin flap or preorbicularis approach; the dashed line represents a stepped, postorbicularis approach; and the dotted line represents a nonsteped, postorbicularis approach.

Figure 5

Example of titanium mesh.

Figure 6

Example of porous polyethylene for orbital floor reconstruction.

Figure 7

Titanium plate mesh for reconstruction of the orbital floor defect.

Figure 8

Correct placement of implant for orbital floor reconstuction.