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Review
. 2023 Feb;124(1):101267.
doi: 10.1016/j.jormas.2022.08.010. Epub 2022 Aug 18.

Assessing effectiveness of endoscope-assisted medial orbital wall fracture repair vs. no surgery using benefit-risk metrics and literature review

Poramate Pitak-Arnnop  1 , Levyn Kay Witohendro  2 , Chatpong Tangmanee  3 , Keskanya Subbalekha  4 , Nattapong Sirintawat  5 , Andreas Neff  6 , Jean-Paul Meningaud  7
Affiliations
Review

Assessing effectiveness of endoscope-assisted medial orbital wall fracture repair vs. no surgery using benefit-risk metrics and literature review

Poramate Pitak-Arnnop et al. J Stomatol Oral Maxillofac Surg. 2023 Feb.

Abstract

Purposes: To evaluate clinical usefulness of endoscope-assisted medial orbital wall fracture repair via the retrocaruncular approach (rc-EAMOWFR) vs. no surgery (NS), and to perform a narrative review of relevant literature.

Methods: This was a retrospective cohort study enrolling isolated medial orbital wall fracture (IMOWF) eyes presented to two German level 1 trauma centers during a 7-year interval. The predictor variable was treatment type (rc-EAMOWFR vs. NS), and the main outcomes were late enophthalmos (LE) and retrobulbar hemorrhage (RH) assessed at 9-15 posttraumatic months. Descriptive and bivariate statistics were computed at α = 95%. Binary adjustments enabled calculation of number needed to treat (NNT), to harm (NNH), and likelihood to be helped or harmed (LHH) for demonstrating benefit-risk tradeoffs. Moreover, a narrative review was also performed.

Results: The sample comprised 502 patients (28.3% females; mean age, 46.5±19.2 years) with 541 IMOWF eyes (5.9% NS; 7.2% LE; 1.3% RH). Operated eyes had significantly lower LE events than NS eyes (symptomatic IMOWF: P < .0001; 95% confidence interval [CI], .03 to .16; NNT = 2 [95% CI, 1.1 to 6.1]; asymptomatic IMOWF: P < .0001; 95% CI, .01 to .07; NNT = 2 [95% CI, 1.1 to 1.8]). There were 7 (1.5%) RH events following rc-EAMOWFR (P = .99; 95% CI, .06 to 17.4; NNH = 68 [95% CI, 38.3 to 254.2]). LHH calculations posited that rc-EAMOWFR was 34 times more likely to prevent LE than to cause RH, regardless of fracture symptoms. Our results conformed to those of other 15 studies.

Conclusions: The results of this study suggest that all IMOWFs be treated. rc-EAMOWFR performed in every 68 IMOWFs would be at risk of one RH event, but prevent 34 eyes from LE due to untreated fractures. Nearly 72% of untreated IMOWFs develop LE after 9 months.

Keywords: Benefit-risk; Endoscope; Enopthalmos; Orbital fracture; Retrobulbar hemorrhage.

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Conflict of interest statement

Declaration of Competing Interest All of the authors indicate full freedom of investigation and manuscript preparation without potential conflict of interest as regards this study. Prof. Dr. Dr. Andreas Neff has served as a consultant to material designs for Medartis (Basel, Switzerland) and has received remuneration for scientific presentations from Karl Storz (Tuttlingen, Germany).

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