Early reconstruction of orbital roof fractures: clinical features and treatment outcomes

Abstract

Background: Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction.

Methods: Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated.

Results: The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected.

Conclusions: Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

Keywords: Optic nerve; Orbital fracture; Postoperative complication.

Fig. 1

Case (A) Preoperative axial view of CT scans of a 26.year-old man showing a displaced orbital roof fracture fragment compressing the optic nerve. (B) Preoperative coronal CT scans showing a displaced orbital roof fracture fragment compressing the optic nerve. (C) Preoperative sagittal CT scans showing a displaced orbital roof fracture fragment compressing the optic nerve (white arrow). (D) Preoperative three-dimensional (3D) facial CT scans showing a displaced orbital roof fracture fragment compressing the optic nerve. (E) Postoperative axial CT scans showing the orbital roof, which was anatomically reconstructed using titanium micro mesh. (F) Postoperative coronal CT scans showing the orbital roof, which was anatomically reconstructed using titanium micro mesh. (G) Postoperative sagittal CT scans showing the orbital roof, which was anatomically reconstructed using titanium micro mesh. (H) Postoperative 3D facial CT scans showing the orbital roof, which was anatomically reconstructed using titanium micro mesh.