The Impact of Surgical Timing in Orbital Fracture Repair: A New Paradigm

Bashar Hassan; Eric Resnick; Seray Er; Fan Liang; Richard Redett; Robin Yang; Paul Manson; Michael Grant

doi:10.1097/PRS.0000000000011420

The Impact of Surgical Timing in Orbital Fracture Repair: A New Paradigm

Plast Reconstr Surg. 2024 Mar 25. doi: 10.1097/PRS.0000000000011420. Online ahead of print.

Authors

Bashar Hassan^{1

2}, Eric Resnick³, Seray Er³, Fan Liang², Richard Redett², Robin Yang², Paul Manson², Michael Grant¹

Affiliations

¹ Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
² Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³ University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 38546673
DOI: 10.1097/PRS.0000000000011420

Abstract

Purpose: For decades, there has been an ongoing debate about the ideal timing of orbital fracture repair (OFR) in adults.

Methods: We conducted a retrospective review of patients who underwent OFR at two centers (2015-2019). Excluded were patients <18 years old and those with follow-up <2 weeks. Our primary outcome was the incidence/persistence of postoperative enophthalmos/diplopia at least 2 weeks following OFR. The association between surgical timing and postoperative ocular complications was assessed in patients with extraocular muscle (EOM) entrapment, enophthalmos and/or diplopia, and different fracture sizes.

Results: Of n=253 patients, n=13 (5.1%) had preoperative EOM entrapment. Of these, patients who had OFR within 2 days of injury were less likely to develop postoperative diplopia compared with patients who had OFR within 8-14 days (n=1/8 [12.5%], n=3/3 [100%]; P=0.018). Patients who had OFR for near-total defects within 1 week of injury were significantly less likely to have postoperative enophthalmos (n=0 [0.0%]) compared with those who had surgery after 2 weeks (n=2 [33.3%] after 15 to 28 days, n=8 [34.8%] after 28 days from injury, P<0.001). Patients who had delayed OFR for large fractures smaller than near-total defects, preoperative persistent diplopia, or enophthalmos were not at significantly greater likelihood of postoperative ocular complications compared with those who had early OFR.

Conclusion: We recommend OFR within 2 days of injury for EOM entrapment and 1 week for near-total defects. Surgical delay up to at least 4 weeks is possible in case of less severe fractures, preoperative persistent diplopia, or enophthalmos.