Evaluation of Classic Criteria for Surgical Repair in Patients with Orbital Floor Fractures and Associated Clinical Outcomes.
Authors: Gabriella Menniti 1, Georges Nassrallah2, Nivdeep Nijhawan2, Jean Deschênes1. 1McGill University, 2University of Toronto.
Author Disclosures: G. Menniti: None. G. Nassrallah: None. N. Nijhawan: None. J. Deschênes: None.
Abstract Body:
Purpose: Orbital floor fractures result from blunt trauma and can lead to permanent visual disturbances. However, careful triage of patients requiring surgery is important as orbital fracture repair itself can induce morbidity. The ophthalmology literature contains criteria for surgical repair based on indications that are associated with worse outcomes. This study aims to assess the value of classic indications of orbital floor fracture repair.
Study Design: Retrospective cohort study.
Methods: Charts of patients with orbital floor fractures at the McGill University Health Centre from August 2015 to January 2018 were retrieved. Data regarding demographics, presenting complaints, physical examination, computed tomography (CT) imaging, management, and surgical outcomes were collected. Indications for surgical repair that were assessed included: floor fracture >=50%, diplopia within 30° of fixation, enophthalmos >2 mm, early enophthalmos at time of presentation, hypoglobus, progressive hypesthesia, suspected entrapment on CT report, oculocardiac reflex, and facial asymmetry. Participants were divided into four groups: “no indications without repair”, “no indications with repair”, “indications without repair”, and “indications with repair.” Primary outcomes were diplopia in any direction of gaze and enophthalmos at last follow-up. Chi-squared test was performed to assess differences in outcomes among the four groups. Bonferroni correction was applied to account for multiple comparisons.
Results: 194 orbits were included. For each surgical indication, when assessed alone, there was no benefit of surgery compared to observation. When surgery was undertaken, indications that predicted improved outcomes included initial diplopia within 30° of fixation (N=21, P=0.01), enophthalmos >2 mm (N=13, P=0.0002), and early enophthalmos (N=12, P=0.0002). For other indications including floor fracture >=50% (N=34), hypoglobus (N=8), progressive hypesthesia (N=17), oculocardiac reflex (N=0), suspected entrapment on CT report (N=28), and facial asymmetry (N=2), there were no statistical differences between groups. When assessing the number of indications present, there was no benefit for surgery compared to observation regardless of the number of indications met. However, when surgery was performed, having at least three indications (N=10) was associated with improvement in enophthalmos (P<0.001).
Conclusions: We found that observation was not significantly different to surgery in patients with classic indications for surgical repair of orbital floor fractures with regard to visual outcomes. Having at least three of the classic indications for orbital floor repair appeared to be a predictor of benefit from repair, however. Future studies with larger populations are needed to further shed light on the value of classic indications for orbital floor repair after trauma.
