The influence of concomitant medial wall fracture on the results of orbital floor reconstruction

Abstract

Introduction: Up to 35% of orbital floor fractures extend to the medial wall. This results in restriction of both abduction and adduction, leading to horizontal diplopia. The greater the defect, the more pronounced the enophthalmos.

Aim of the study: The aim of the study was to determine the influence of concomitant medial wall defects on enophthalmos and diplopia, and the influence of intraoperative revision on the results of surgical reconstruction in patients with orbital floor fracture.

Material and methods: 78 cases of orbital floor fracture, with or without concomitant medial wall defect, were retrospectively analyzed. Reconstruction surgeries were performed in a similar fashion, but with variation in the alloplastic materials used. Careful investigation of the area was performed during the surgery.

Results: Patients with associated medial wall defects had significantly more pronounced enophthalmos than those with isolated floor fracture, with no such difference after the orbital reconstruction. Postoperative vertical diplopia was more common in patients with an associated medial defect.

Conclusions: Associated medial wall defect leads to more severe enophthalmos at presentation. However, if the medial aspect of the orbital wall is revised properly, postoperative outcomes are not inferior to those in cases of isolated floor fracture.

Keywords: Diplopia; Enophthalmos; Medial orbital wall; Orbital fracture; Reconstruction.