Long term complications of orbital floor fracture repair
PR Boulos | PG Harris | C Cordoba | H Ciaburro | G Frenette
To search for complications of orbital floor fracture
repair that occur late postoperatively, to reveal their
natural course and to attempt to associate the complications with variables
that are possibly involved in their genesis.
METHODS: A retrospective comparative case series
of all orbital floor fracture repair cases (158 eyes)
from 1983 to 1998 was done. Synthetic prostheses were tailored to the orbital floor
in clinically significant fractures. Bone grafts were
chosen for large defects, comminuted fractures or if
other reconstruction (eg, sinus) was required.
Variables studied included age, sex, trauma to surgery
time lag, surgeon, fracture type, length of surgery,
antibiotics, prosthesis material, hospital stay and
follow-up. These variables were tested for association
with the following complications: altered vision, diplopia,
dysesthesia, ectropion, pain, infection, enophthalmos
and extrusion. Occurrence and resolution data were collected.
RESULTS: One of four complications (often more
than one per eye) resolved without surgery. Reintervention
resolved one of three complications. Of all patients,
39.2% remain with long term unresolved complications.
Altered vision is more probable with older patients
and with longer surgeries. Diplopia was least likely
to occur with orbitozygomatic or panfacial fractures
and more probable with bone grafts. Ectropion and epiphora
increased with a fracture's severity. Pain was mostly
attributable to bone grafts. Enophthalmos was mainly
due to large or comminuted fractures. Infection and
extrusion were rare. Sex, surgeon and trauma to surgery
time lag had no bearing on the incidence of complications.
CONCLUSIONS: Delaying surgery did not seem to
influence complications. Lessening ocular manipulation
during longer surgeries may reduce vision changes. The
only truly modifiable variable was the material used
for orbital floor repair. Alloplastic prostheses should
be used, but if large or comminuted fractures are involved,
bone grafting is an interesting first choice.