Traumatic optic neuropathy after maxillofacial trauma: a review of 8 cases

Abstract

Purpose: To study the incidence and prognostic factors of traumatic optic neuropathy in maxillofacial trauma cases.

Material and method: Eight patients diagnosed with traumatic optic neuropathy among 354 cases of maxillofacial trauma treated from December 2008 through May 2011 were included in this retrospective study. Factors at the time of trauma, clinical findings, computed tomographic findings, and interventional modalities were studied for any improvement in vision.

Results: Of 354 maxillofacial trauma cases, 8 cases (2.25%) were diagnosed with traumatic optic neuropathy. Patients' ages ranged from 21 to 60 years. The causes of trauma were road traffic accidents in 7 patients and surgery for zygomaticomaxillary complex (ZMC) fractures in 1 patient. All patients had ZMC fracture; 1 patient had Le Fort II, mandible condyle, and ramus fractures and 2 had associated cranial bone fracture. Six patients were administered steroid therapy; 1 patient showed improvement in visual acuity. Two patients underwent decompression by a lateral orbital approach; 1 patient showed an improvement in visual acuity. In 2 other patients, a spontaneous recovery was observed. Four of the 8 patients underwent open reduction and fixation of the maxillofacial fractures. Of the remaining patients, 1 patient had a nondisplaced ZMC fracture that was treated without surgical intervention and the other 3 patients refused any surgical intervention.

Conclusions: The present findings showed the occurrence of traumatic optic neuropathy in association with ZMC, Le Fort II, and cranial bone fractures. Additional risk factors such as a history of a loss of consciousness, injury to the superolateral orbital region, fracture of the optic canal, evidence of orbital hemorrhage, and evidence of blood within the posterior ethmoidal cells should be considered during the evaluation.