A Functional Radiological and Soft Tissue Classification to Predict Outcomes in Orbital Fracture Surgery in a Multidisciplinary "Real-World" Setting

Elizabeth Yang; Shu-Yi Claire Chan; Yara Al-Omari; Louise Ward; Timothy E Yap; Aneka Jhass; Ravi Pancholi; Ahmad Aziz; Christopher Richard Bentley; Michael Perry; Vickie Lee

doi:10.3389/fsurg.2021.693607

A Functional Radiological and Soft Tissue Classification to Predict Outcomes in Orbital Fracture Surgery in a Multidisciplinary "Real-World" Setting

Front Surg. 2021 Jul 27:8:693607. doi: 10.3389/fsurg.2021.693607. eCollection 2021.

Authors

Elizabeth Yang¹, Shu-Yi Claire Chan², Yara Al-Omari¹, Louise Ward¹, Timothy E Yap^{2

3}, Aneka Jhass¹, Ravi Pancholi¹, Ahmad Aziz^{2

3}, Christopher Richard Bentley^{2

3}, Michael Perry¹, Vickie Lee^{1

3}

Affiliations

¹ Ophthalmology Department, London North West University Healthcare Trust, London, United Kingdom.
² Imperial College London, London, United Kingdom.
³ Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom.

Abstract

Purpose: The decision for open reduction and internal fixation (ORIF) of orbital fractures is usually based on clinical severity and soft tissue and bony findings. This study aimed to identify prognostic factors for a successful surgical outcome. Materials and Methods: We included all orbital fractures treated by ORIF referred to the Ophthalmology clinic for assessment over a 12-year period. A successful outcome was defined as (i) a single operation, (ii) improved diplopia and globe position at 6 months, (iii) no surgical complications, and (iv) patient satisfaction. Data was collected on presenting symptoms, orthoptic measurements, time interval from injury to surgery, fracture geometry and involvement of internal, and external bony landmarks. Univariate and multivariate regression was used to identify predictive factors for success. Results: There were 143 cases with median age 35.4 years and 81.8% (117/143) male. 51% (73/143) were complex fractures involving multiple orbital walls. 63.6% (91/143) achieved significant improvement in both enophthalmos and diplopia at 6 months. 15.3% (22/143) had significant preoperative soft tissue or neurogenic injury. 11.8% (17/143) required orbital plate repositioning or removal. 1.4% (2/143) developed orbital haematoma and 4.2% (6/143) had cicatricial entropion. Pre-operative nerve or muscle damage (OR 0.05, p = 0.01) and infraorbital fissure fracture (OR 0.38, p = 0.04) were associated with poor outcomes, whereas an intact posterior ledge was associated with successful outcomes (OR 3.03, p = 0.02). Conclusion: Careful ocular motility evaluation to ascertain neurogenic injury and muscle compartment syndrome, and radiological analysis of the integrity of the posterior ledge and the inferior orbital fissure can facilitate management and expectations of ORIF surgery.

Keywords: CT analysis; blow-out fracture of the orbit; orbital fracture ORIF; orbital fractures; orbital reconstruction; trauma.