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Radiologic and Long-Term Clinical Outcome From Treatment of Isolated Medial Orbital Wall Blowout Fractures

Saiepour, Daniel MD, PhD; Messo, Elias DDS; Hedlund, Anders J.O. MD; Nowinski, Daniel J. MD, PhD

doi: 10.1097/SCS.0b013e31825e4e8e
Original Articles

Abstract: Blowout fractures in the medial orbital wall may lead to enophthalmos, ocular dysmotility, and diplopia. Ten consecutive patients with unilateral, isolated fractures of the medial orbital wall were retrospectively studied. The radiologic accuracy of the medial orbital wall reconstructions and the long-term clinical outcomes were assessed. All cases were treated through a bicoronal approach and by use of porous polyethylene-titanium implants. The total fracture area and the orbital volume increase from the blowout were measured on computed tomographic scans. Next, we evaluated the reconstruction in the posterior part of the medial wall. This was done by calculating the ratio between the defect area and the implant area located behind the anterior ethmoidal canal. The patients were examined at least 1 year after the operation, and the rates of enophthalmos and diplopia were evaluated. The mean fracture defect area was 2.45 cm2 (range, 0.41–4.16 cm2), and the mean volume increase from the blowout fractures was 1.82 cm3 (range, 0.53–2.76 cm3). The orbital volume was accurately restored in all patients. However, the ratio of implant to defect area behind the anterior ethmoidal canal ranged from 0% to 100% (mean, 47.3%). None of the patients had enophthalmos or diplopia at the long-term follow-up. The results confirm that restoration of orbital volume is important to prevent postoperative enophthalmos in isolated medial orbital blowout fractures. Complete reconstruction of the most posterior part of the medial orbital wall seems to be of lesser importance.

From the Uppsala Craniofacial Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.

Received April 10, 2012.

Accepted for publication May 4, 2012.

Address correspondence and reprint requests to Dr. Daniel J. Nowinski, Uppsala Craniofacial Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; E-mail: Daniel.nowinski@akademiska.se; daniel.nowinski@surgsci.uu.se

The study was supported by Samverkansfonden Uppsala-Örebro.

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD