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Lorena LoVerde, Anjali B Sheth, Jay M Lustbader; Orbital Fractures: Timing of Surgical Repair Among Different Surgical Specialties. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4076.
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This study was designed to evaluate the rate and time of repair of orbital fractures among different surgical subspecialties including ophthalmology, otolaryngology (ENT) and oral maxillofacial surgery (OMFS). We also evaluated postoperative extraocular muscle restriction in immediate versus delayed repair and symptoms with observation versus repair.
A retrospective chart review was performed of 124 ophthalmology trauma consults at Medstar Washington Hospital Center from August 2012 - January 2013. 84 of these patients had orbital fractures. These consults were analyzed to see if ENT or OMFS were consulted and if the orbital fractures were repaired. The orbital fractures that were repaired were then analyzed regarding time to repair and restriction of motility postoperatively.
We found that the majority (82%) of fractures were not repaired. Of the minority that were repaired, OMFS repaired with the highest frequency (60%). Ophthalmology and ENT each repaired 20% of the cases. OMFS and ENT repaired at an average of 2 days post injury, whereas ophthalmology repaired at an average of 11 days. Patients with restriction before repair had restriction after surgery. Of the 12 patients who were repaired within one week, there were 3 patients with restriction preoperatively and 2 with restriction postoperatively; 1 patient did not follow up. Of the patients who had full motility preoperatively and followed up, all had full motility postoperatively. Of the patients who were repaired after one week, 2 were restricted preoperatively and postoperatively. The clinical significance of the amount of restriction was not specified in the records. Of the patients who were not repaired and had restriction on presentation, the majority did not follow up (58%). Of those who did follow up, most (80%) had full movement.
There is no difference in terms of restriction of extraocular movement secondary to orbital fracture when repaired after one week compared to repair within one week. Further, many patients who present with restriction of extraocular movement will have resolution of restriction with time. Of all specialties, OMFS surgeons repaired with the highest frequency. ENT and OMFS surgeons also repaired fractures earlier than ophthalmologists.
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