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Classification and Surgical Management of Orbital Fractures: Experience With 111 Orbital Reconstructions

Manolidis, S.*; Weeks, B. H.*; Kirby, M.*; Scarlett, M.; Hollier, L.

Journal of Craniofacial Surgery: November 2002 - Volume 13 - Issue 6 - p 726-737
Original Articles

Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.

Houston, Texas

Charleston, South Carolina

From *Bobby R. Alford Department of Otolaryngology–Head & Neck Surgery and Communicative Sciences, Baylor College of Medicine, Houston, Texas, U. S. A.; University of South Carolina Department of Otolaryngology–Head & Neck Surgery and Surgery, Charleston, South Carolina, U. S. A.; and Department of Plastic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.

Address correspondence and reprint requests to Dr. Spiros Manolidis, 6550 Fannin Street, SMTH1727, Houston, TX 77002. E-mail:

Presented at the American Academy of Otolaryngology–Head & Neck Surgery Meeting, Washington, DC, September 27, 2000.

© 2002 Mutaz B. Habal, MD