Early Surgical Management of Displaced Orbital Roof Fractures: Prospective Observational Study

Omer Mohammed Jamali; Mohammed Esmail Al-Sabahi; Mohamed Shawky; Mohammed Atef

doi:10.1007/s12070-023-04056-x

Early Surgical Management of Displaced Orbital Roof Fractures: Prospective Observational Study

Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3770-3777. doi: 10.1007/s12070-023-04056-x. Epub 2023 Jul 22.

Authors

Omer Mohammed Jamali^{1

2}, Mohammed Esmail Al-Sabahi³, Mohamed Shawky⁴, Mohammed Atef⁴

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Al-Amal Al Arabi Specialized Hospital, Hodeida, Yemen.
² Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hodeida University, Hodeida, Yemen.
³ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
⁴ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt.

PMID: 37974754
PMCID: PMC10645907 (available on 2024-12-01)
DOI: 10.1007/s12070-023-04056-x

Abstract

This study aimed to evaluate the clinical, radiological and functional outcome of early (within 24 h) surgical intervention of displaced orbital roof fractures. This is a prospective observational study for patients with displaced orbital roof fractures. Six patients underwent early surgical management within hours of admission. The primary outcome variables were functional and aesthetic (evaluated through clinical and radiological assessments). The rate of immediate and delayed complications over a 6-months minimum follow-up period was recorded. All patients were males. The median age at the time of presentation was 23.5 years ranging from 4 to 40 years. The etiology was a high impact traffic accident in all patients. In three patients, the orbital roof fractures were unilateral, and in the other three patients, the fractures were bilateral. All patients were treated via transcranial approach at the same time as the neurosurgery. The median follow-up period was 10 months ranging from 6 to 15 months. During the follow-up period, there were no signs of meningitis, cerebrospinal fluid leakage, facial asymmetry, enophthalmos, exophthalmos, restriction of ocular motility, or blindness. Traumatic optic neuropathy was present in two patients (one unilateral and the other bilateral), of whom, one patient achieved full visual acuity recovery, while the other patient showed a mild decrease in visual acuity which improved within 6 months (OD;20/30, OS;20/25). One patient had mild ptosis and recovered spontaneously within 3 months after surgery. Postoperative CT scans showed a good anatomical reconstruction of orbital roof fracture in all cases. Early definite management of displaced orbital roof fractures secures reliable functional and cosmetic results and reduces the incidences of intracranial and ocular complications.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04056-x.

Keywords: Acute traumatic orbital encephalocele; Optic nerve; Orbital fracture.

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