A prospective study of orbital fracture sequelae after change of surgical routines.

PURPOSE: The present study was undertaken to investigate the circumstances surrounding the considerable increase in the number of orbital floor fracture repairs at the ORL Clinic at Sahlgrenska University Hospital at the end of the 1990s.

PATIENTS AND METHODS: All the patients during a period of 1 year with a fracture involving the orbital floor were followed for 1 year using clinical assessments and questionnaires. Etiology, surgical methods, and the occurrence of long-term sequelae were investigated.

RESULTS: Fifty-one patients were included. The main etiologies were assaults and falls. Surgery of the internal orbit was performed in 76%, often combined with a Gillies reduction. Porous polyethylene sheets (Medpor; Porex Surgical Inc, Newnan, GA) were used for the repair of large floor defects. Compared with previous results, the number of computed tomography investigations had considerably increased. The number of operations on the internal orbit due to fractures had doubled. The occurrence of diplopia was reduced compared with the situation when the floor was stabilized with an antral packing. Late enophthalmos developed in 11%. Despite fixation, the majority (67%) reported permanently affected sensibility.

CONCLUSION: The frequency and severity of diplopia decreased parallel to the introduction of Medpor implants and the termination of the antral packing technique. Tetrapod zygomatic fractures, possibly unnecessarily submitted for surgery of the internal orbit, were in part responsible for the increase in the number of orbital explorations, in spite of preceding computed tomography scans. This indicates inadequate diagnostic techniques. Studies evaluating alternative complementary diagnostic methods are in progress.