Management of Orbital Floor Fractures

Tom Shokri; Mark Alford; Matthew Hammons; Yadranko Ducic; Mofiyinfolu Sokoya

doi:10.1055/s-0039-1700852

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2019; 35(06): 633-639
DOI: 10.1055/s-0039-1700852

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Orbital Floor Fractures

Tom Shokri

¹Department of Otolaryngology – Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania

,

Mark Alford

²Ophthalmic Plastic Surgery, North Texas Ophthalmic Plastic Surgery, Fort Worth, Texas

,

Matthew Hammons

²Ophthalmic Plastic Surgery, North Texas Ophthalmic Plastic Surgery, Fort Worth, Texas

,

Yadranko Ducic

³Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas

,

Mofiyinfolu Sokoya

³Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas

› Author Affiliations

Abstract

Fractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. Repair of these injuries should be carried out with the goal of restoring normal orbital volume, facial contour, and ocular motility. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. This article aims to review concepts on the management of orbital floor fractures in the hope of further elucidating perioperative evaluation and decision-making regarding operative intervention.

Keywords

orbital reconstruction - orbital blowout - orbital floor fracture

Full Text

References

References
1 René C. Update on orbital anatomy. Eye (Lond) 2006; 20 (10) 1119-1129
2 Schuknecht B, Carls F, Valavanis A, Sailer HF. CT assessment of orbital volume in late post-traumatic enophthalmos. Neuroradiology 1996; 38 (05) 470-475
3 Warwar RE, Bullock JD, Ballal DR, Ballal RD. Mechanisms of orbital floor fractures: a clinical, experimental, and theoretical study. Ophthal Plast Reconstr Surg 2000; 16 (03) 188-200
4 Le Fort R. Etude experimentale sur les fractures de la machoire superieure. Rev Chir Paris 1901; 23: 208-479
5 Tessier P. The classic reprint: experimental study of fractures of the upper jaw. 3. René Le Fort, M.D., Lille, France. Plast Reconstr Surg 1972; 50 (06) 600-607
6 Tessier P. The classic reprint. Experimental study of fractures of the upper jaw. I and II. René Le Fort, M.D. Plast Reconstr Surg 1972; 50: 497-506 contd
7 Fujino T. Experimental “blowout” fracture of the orbit. Plast Reconstr Surg 1974; 54 (01) 81-82
8 Pfeiffer RL. Traumatic Enophthalmos. Trans Am Ophthalmol Soc 1943; 41: 293-306
9 Ahmad F, Kirkpatrick NA, Lyne J, Urdang M, Waterhouse N. Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction?. J Craniofac Surg 2006; 17 (03) 438-441
10 Waterhouse N, Lyne J, Urdang M, Garey L. An investigation into the mechanism of orbital blowout fractures. Br J Plast Surg 1999; 52 (08) 607-612
11 Tajima S, Fujino T, Oshiro T. Mechanism of orbital blowout fracture. I. Stress coat test. Keio J Med 1974; 23 (02) 71-75
12 Nagasao T, Miyamoto J, Jiang H, Tamaki T, Kaneko T. Interaction of hydraulic and buckling mechanisms in blowout fractures. Ann Plast Surg 2010; 64 (04) 471-476
13 Smith B, Regan Jr WF. Blow-out fracture of the orbit; mechanism and correction of internal orbital fracture. Am J Ophthalmol 1957; 44 (06) 733-739
14 Grant III JH, Patrinely JR, Weiss AH, Kierney PC, Gruss JS. Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg 2002; 109 (02) 482-489 , discussion 490–495
15 Soll DB, Poley BJ. Trapdoor variety of blowout fracture of the orbital floor. Am J Ophthalmol 1965; 60: 269-272
16 Holt GR, Holt JE. Management of orbital trauma and foreign bodies. Otolaryngol Clin North Am 1988; 21 (01) 35-52
17 Chen CT, Wang TY, Tsay PK, Huang F, Lai JP, Chen YR. Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases. Plast Reconstr Surg 2010; 126 (01) 205-212
18 Evans HH, Wurth BA, Penna KJ. Superior orbital fissure syndrome: a case report. Craniomaxillofac Trauma Reconstr 2012; 5 (02) 115-120
19 Rohrich RJ, Hackney FL, Parikh RS. Superior orbital fissure syndrome: current management concepts. J Craniomaxillofac Trauma 1995; 1 (02) 44-48
20 Zachariades N. The superior orbital fissure syndrome. Review of the literature and report of a case. Oral Surg Oral Med Oral Pathol 1982; 53 (03) 237-240
21 Hedstrom J, Parsons J, Maloney PL, Doku HC. Superior orbital fissure syndrome: report of case. J Oral Surg 1974; 32 (03) 198-201
22 Kurzer A, Patel MP. Superior orbital fissure syndrome associated with fractures of the zygoma and orbit. Plast Reconstr Surg 1979; 64 (05) 715-719
23 Yeh S, Foroozan R. Orbital apex syndrome. Curr Opin Ophthalmol 2004; 15 (06) 490-498
24 Spoor TC, Hartel WC, Lensink DB, Wilkinson MJ. Treatment of traumatic optic neuropathy with corticosteroids. Am J Ophthalmol 1990; 110 (06) 665-669
25 Steinsapir KD, Goldberg RA. Traumatic optic neuropathy. Surv Ophthalmol 1994; 38 (06) 487-518
26 Steinsapir KD, Seiff SR, Goldberg RA. Traumatic optic neuropathy: where do we stand?. Ophthal Plast Reconstr Surg 2002; 18 (03) 232-234
27 Yang QT, Zhang GH, Liu X, Ye J, Li Y. The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy. J Trauma Acute Care Surg 2012; 72 (05) 1350-1355
28 Acartürk S, Seküçoğlu T, Kesiktäs E. Mega dose corticosteroid treatment for traumatic superior orbital fissure and orbital apex syndromes. Ann Plast Surg 2004; 53 (01) 60-64
29 Rosenbaum AL, Santiago AP. Clinical strabismus management: principles and surgical techniques. David Hunter; 1999
30 Bite U, Jackson IT, Forbes GS, Gehring DG. Orbital volume measurements in enophthalmos using three-dimensional CT imaging. Plast Reconstr Surg 1985; 75 (04) 502-508
31 Manson PN, Grivas A, Rosenbaum A, Vannier M, Zinreich J, Iliff N. Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative computed tomography. Plast Reconstr Surg 1986; 77 (02) 203-214
32 Parsons GS, Mathog RH. Orbital wall and volume relationships. Arch Otolaryngol Head Neck Surg 1988; 114 (07) 743-747
33 Forbes G, Gehring DG, Gorman CA, Brennan MD, Jackson IT. Volume measurements of normal orbital structures by computed tomographic analysis. AJR Am J Roentgenol 1985; 145 (01) 149-154
34 Whitehouse RW, Batterbury M, Jackson A, Noble JL. Prediction of enophthalmos by computed tomography after ‘blow out’ orbital fracture. Br J Ophthalmol 1994; 78 (08) 618-620
35 Tabatabaei SA, Soleimani M, Alizadeh M. , et al. Predictive value of visual evoked potentials, relative afferent pupillary defect, and orbital fractures in patients with traumatic optic neuropathy. Clin Ophthalmol 2011; 5: 1021-1026
36 Alford MA, Nerad JA, Carter KD. Predictive value of the initial quantified relative afferent pupillary defect in 19 consecutive patients with traumatic optic neuropathy. Ophthal Plast Reconstr Surg 2001; 17 (05) 323-327
37 Gilbard SM, Mafee MF, Lagouros PA, Langer BG. Orbital blowout fractures. The prognostic significance of computed tomography. Ophthalmology 1985; 92 (11) 1523-1528
38 Ploder O, Klug C, Voracek M, Burggasser G, Czerny C. Evaluation of computer-based area and volume measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor. J Oral Maxillofac Surg 2002; 60 (11) 1267-1272 , discussion 1273–1274
39 Grove Jr AS, Tadmor R, New PF, momose KJ. Orbital fracture evaluation by coronal computed tomography. Am J Ophthalmol 1978; 85 (5 Pt 1): 679-685
40 Cole P, Boyd V, Banerji S, Hollier Jr LH. Comprehensive management of orbital fractures. Plast Reconstr Surg 2007; 120 (07) (Suppl. 02) 57S-63S
41 Hawes MJ, Dortzbach RK. Surgery on orbital floor fractures. Influence of time of repair and fracture size. Ophthalmology 1983; 90 (09) 1066-1070
42 Harris GJ, Garcia GH, Logani SC, Murphy ML, Sheth BP, Seth AK. Orbital blow-out fractures: correlation of preoperative computed tomography and postoperative ocular motility. Trans Am Ophthalmol Soc 1998; 96: 329-347 , discussion 347–353
43 Higashino T, Hirabayashi S, Eguchi T, Kato Y. Straightforward factors for predicting the prognosis of blow-out fractures. J Craniofac Surg 2011; 22 (04) 1210-1214
44 Schouman T, Courvoisier DS, Van Issum C, Terzic A, Scolozzi P. Can systematic computed tomographic scan assessment predict treatment decision in pure orbital floor blowout fractures?. J Oral Maxillofac Surg 2012; 70 (07) 1627-1632
45 Goggin J, Jupiter DC, Czerwinski M. Simple computed tomography-based calculations of orbital floor fracture defect size are not sufficiently accurate for clinical use. J Oral Maxillofac Surg 2015; 73 (01) 112-116
46 Choi SH, Kang DH, Gu JH. The correlation between the orbital volume ratio and enophthalmos in unoperated blowout fractures. Arch Plast Surg 2016; 43 (06) 518-522
47 Aldekhayel S, Aljaaly H, Fouda-Neel O, Shararah AW, Zaid WS, Gilardino M. Evolving trends in the management of orbital floor fractures. J Craniofac Surg 2014; 25 (01) 258-261
48 Cruz AA, Eichenberger GC. Epidemiology and management of orbital fractures. Curr Opin Ophthalmol 2004; 15 (05) 416-421
49 Burnstine MA. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology 2002; 109 (07) 1207-1210 , discussion 1210–1211, quiz 1212–1213
50 Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg 1998; 14 (06) 379-390
51 Burnstine MA. Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol 2003; 14 (05) 236-240
52 Harley RD. Surgical management of persistent diplopia in blowout fractures of the orbit. Ann Ophthalmol 1975; 7 (12) 1621-1626
53 Wachler BS, Holds JB. The missing muscle syndrome in blowout fractures: an indication for urgent surgery. Ophthal Plast Reconstr Surg 1998; 14 (01) 17-18
54 Sires BS, Stanley Jr RB, Levine LM. Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol 1998; 116 (07) 955-956
55 Ellis III E. Orbital trauma. Oral Maxillofac Surg Clin North Am 2012; 24 (04) 629-648
56 Grant III JH, Patrinely JR, Weiss AH, Kierney PC, Gruss JS. Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg 2002; 109 (02) 482-489 , discussion 490–495
57 Banerjee A, Moore CC, Tse R, Matic D. Rounding of the inferior rectus muscle as an indication of orbital floor fracture with periorbital disruption. J Otolaryngol 2007; 36 (03) 175-180
58 Levine LM, Sires BS, Gentry LR, Dortzbach RK. Rounding of the inferior rectus muscle: a helpful radiologic findings in the management of orbital floor fractures. Ophthal Plast Reconstr Surg 1998; 14 (02) 141-143
59 Matic DB, Tse R, Banerjee A, Moore CC. Rounding of the inferior rectus muscle as a predictor of enophthalmos in orbital floor fractures. J Craniofac Surg 2007; 18 (01) 127-132
60 Boush GA, Lemke BN. Progressive infraorbital nerve hypesthesia as a primary indication for blow-out fracture repair. Ophthal Plast Reconstr Surg 1994; 10 (04) 271-275
61 Peltomaa J, Rihkanen H. Infraorbital nerve recovery after minimally dislocated facial fractures. Eur Arch Otorhinolaryngol 2000; 257 (08) 449-452
62 Rinna C, Ungari C, Saltarel A, Cassoni A, Reale G. Orbital floor restoration. J Craniofac Surg 2005; 16 (06) 968-972
63 Kwon JH, Kim JG, Moon JH, Cho JH. Clinical analysis of surgical approaches for orbital floor fractures. Arch Facial Plast Surg 2008; 10 (01) 21-24
64 Kothari NA, Avashia YJ, Lemelman BT, Mir HS, Thaller SR. Incisions for orbital floor exploration. J Craniofac Surg 2012; 23 (07) (Suppl. 01) 1985-1989
65 Malhotra R, Saleh GM, de Sousa JL, Sneddon K, Selva D. The transcaruncular approach to orbital fracture repair: ophthalmic sequelae. J Craniofac Surg 2007; 18 (02) 420-426
66 Lorenz HP, Longaker MT, Kawamoto Jr HK. Primary and secondary orbit surgery: the transconjunctival approach. Plast Reconstr Surg 1999; 103 (04) 1124-1128
67 Yamashita M, Kishibe M, Shimada K. Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions. J Craniofac Surg 2014; 25 (04) 1183-1186
68 Potter JK, Malmquist M, Ellis III E. Biomaterials for reconstruction of the internal orbit. Oral Maxillofac Surg Clin North Am 2012; 24 (04) 609-627
69 Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013; 71 (03) 550-570
70 Dubois L, Steenen SA, Gooris PJ, Bos RR, Becking AG. Controversies in orbital reconstruction-III. Biomaterials for orbital reconstruction: a review with clinical recommendations. Int J Oral Maxillofac Surg 2016; 45 (01) 41-50
71 Bratton EM, Durairaj VD. Orbital implants for fracture repair. Curr Opin Ophthalmol 2011; 22 (05) 400-406
72 Hollier LH, Rogers N, Berzin E, Stal S. Resorbable mesh in the treatment of orbital floor fractures. J Craniofac Surg 2001; 12 (03) 242-246
73 Romano JJ, Iliff NT, Manson PN. Use of Medpor porous polyethylene implants in 140 patients with facial fractures. J Craniofac Surg 1993; 4 (03) 142-147
74 Losee JE, Afifi A, Jiang S. , et al. Pediatric orbital fractures: classification, management, and early follow-up. Plast Reconstr Surg 2008; 122 (03) 886-897
75 Rottgers SA, Decesare G, Chao M. , et al. Outcomes in pediatric facial fractures: early follow-up in 177 children and classification scheme. J Craniofac Surg 2011; 22 (04) 1260-1265
76 Anderson PJ, Poole MD. Orbital floor fractures in young children. J Craniomaxillofac Surg 1995; 23 (03) 151-154
77 Eppley BL. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac Surg 2005; 63 (03) 385-391
78 Kim HS, Kim SD, Kim CS, Yum MK. Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children. Anaesthesia 2000; 55 (09) 847-852
79 Crumley RL, Leibsohn J, Krause CJ, Burton TC. Fractures of the orbital floor. Laryngoscope 1977; 87 (06) 934-947
80 Timoney PJ, Krakauer M, Wilkes BN, Lee HB, Nunery WR. Nylon foil (supramid) orbital implants in pediatric orbital fracture repair. Ophthal Plast Reconstr Surg 2014; 30 (03) 212-214
81 Biesman BS, Hornblass A, Lisman R, Kazlas M. Diplopia after surgical repair of orbital floor fractures. Ophthal Plast Reconstr Surg 1996; 12 (01) 9-16 , discussion 17
82 Gosse EM, Ferguson AW, Lymburn EG, Gilmour C, MacEwen CJ. Blow-out fractures: patterns of ocular motility and effect of surgical repair. Br J Oral Maxillofac Surg 2010; 48 (01) 40-43
83 Greenwald Jr HS, Keeney AH, Shannon GM. A review of 128 patients with orbital fractures. Am J Ophthalmol 1974; 78 (04) 655-664
84 Brucoli M, Arcuri F, Cavenaghi R, Benech A. Analysis of complications after surgical repair of orbital fractures. J Craniofac Surg 2011; 22 (04) 1387-1390
85 Raschke G, Rieger U, Bader RD, Schaefer O, Guentsch A, Schultze-Mosgau S. Outcomes analysis of eyelid deformities using photograph-assisted standardized anthropometry in 311 patients after orbital fracture treatment. J Trauma Acute Care Surg 2012; 73 (05) 1319-1325
86 Bell RB, Markiewicz MR. Computer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: a descriptive study in a preliminary cohort. J Oral Maxillofac Surg 2009; 67 (12) 2559-2570
87 Shaye DA, Tollefson TT, Strong EB. Use of intraoperative computed tomography for maxillofacial reconstructive surgery. JAMA Facial Plast Surg 2015; 17 (02) 113-119