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K. Pierce, D. Holck; Complications of Orbital Fracture Repair: A Ten Year Review. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3580.
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To show the complication rates of surgical repair of orbital trauma when assessed in a level one trauma center when multiple surgical services are utilized.
Wilford Hall Medical Center and Brook Army Medical Center are level one trauma centers in San Antonio, TX. Facial trauma services consist of oculofacial plastics, oral and maxillofacial surgery, otolaryngology, and plastic surgery. Operative logs from Jan 1995 to Jan 2005 were reviewed from oculofacial trauma cases. Review included only those fractures taken to the operating room, primary trauma and referral cases. Records had to include operative reports and pre and postoperative imaging studies. Exclusions included those without orbital imaging, inadequate/incomplete records and extensive fractures with difficult to measure clinical endpoints. End points were measured as any worsening or objective non-improvement after surgical intervention. Acute versus chronic categories were utilized.
376 orbitofacial fractures of which 297 procedures on 273 patients were included. 224 (82%) were males with 49 (18%) females. Etiologies of fractures in order of frequency included assault, MVA, sports injuries, explosive devices and gun shot wounds. Of the 297 procedures 15.8% had acute complications and 15.1% chronic. Of the acute 19 (6.5%) had lid malposition, 9 (3.1%) orbital soft tissue incarceration, 8 (2.7%) infection, 6 (2%) hemorrhages, 2 (0.7%) optic neuropathy, and 2 (0.7%) inappropriate return to the operating room. Of the chronic cases, 17 (5.7%) had enophthalmos/hypoglobus from inadequate orbital volume reduction and uncorrected medial wall fractures. Hyperglobus had 11 (3.8%), Eyelid/soft tissue abnormalities 9 (3.1%), infection 4 (1.7%), and implant instability 4 (1.7%). When reviewed by fracture pattern, complications from orbital fractures with LeForte/Panfacial were 23/49 (47%), orbital fractures with rim 29/66 (44%) internal orbital floor/medial wall together 27/79 (34%), and internal orbital floor/medial wall alone 12/103 (11.7%).
Of the acute complications lid malposition was the most common followed by orbital soft tissue incarceration. Of the chronic enophthalmos cases most were due to inadequate orbital volume reduction and uncorrected medial wall fractures. Complications were also more common with combined orbital rim fractures and medial wall and floor fractures. Better evaluation of each orbitofacial trauma should include preoperative evaluations both clinically and with computerized tomography. Re-evaluation of implant material utilized should be on a case by case basis to ensure adequate strength, fixation and closure techniques.
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