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
1   Department of Otolaryngology – Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Mark Alford
2   Ophthalmic Plastic Surgery, North Texas Ophthalmic Plastic Surgery, Fort Worth, Texas
,
Matthew Hammons
2   Ophthalmic Plastic Surgery, North Texas Ophthalmic Plastic Surgery, Fort Worth, Texas
,
Yadranko Ducic
3   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Mofiyinfolu Sokoya
3   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
29 November 2019 (online)

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.

 
  • 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