Orbital Fractures Treated in Auckland From 2016 to 2020: Review of Patient Outcomes

Abstract

Orbital reconstruction is a complex procedure demanding accurate placement of implants to restore volume and anatomic shape to the orbits. Intra-operative computed-tomography (CT) and rapid-prototype (RP) biomodels have been recently introduced as surgical aids to improve outcomes. Investigation is required to determine if there is a reduction in post-operative ophthalmic complications.

Study design: Retrospective cohort study.

Objective: To evaluate the impact of intra-operative CT and RP biomodels on the incidence of post-operative diplopia, paraesthesia, cosmetic issues and ability to return to work following orbital reconstruction surgery.

Methods: Adult (>18 years) patients treated at Counties Manukau District Health Board, Auckland, by the Department of Oral and Maxillofacial Surgery for isolated orbital fractures were retrospectively enrolled into this study. An audit of clinical records was undertaken to determine incidences of diplopia, altered sensation, cosmetic concerns and ability to return to work. These findings were compared against our previous audit which documented these findings in patients treated between 2010 and 2015, prior to the introduction of intra-operative CT and RP biomodels.

Results: Routine use of intra-operative CT and RP biomodels was associated with a reduced incidence of post-operative diplopia. No significant difference was observed with regards to paraesthesia and cosmetic deficits.

Conclusions: The relatively low radiation exposure and cost associated with intra-operative CT and RP biomodels is justified with improved outcomes in subjective diplopia. Titanium as a material for orbital reconstruction was confirmed to be associated with low complication rates.

Keywords: diplopia; enophthalmos; fracture; orbit; titanium; trauma.