[Methodology of surgical management of orbital floor fractures: a comparison from ophthalmologic viewpoint between implant and antral balloon].

BACKGROUND

Several methods are available for treatment of orbital floor fractures: antral balloon catheters, orbital implants, combinations of both methods, or no treatment at all. This study compares the outcome of the different surgical approaches.

PATIENTS AND

METHODS

In a retrospective study 153 patients with unilateral orbital floor fractures were analysed with particular emphasis on the extend of the fracture regarding to Motility, enophthalmos, globe position and loss of sensitivity as analytical parameters.

RESULTS

After treatment with antral balloon catheters development of motility in the upper field of gaze was significantly better (p < 0.03) than using combinations of antral balloon catheters and implants. In addition least enophthalmos and bulbus deviation resulted from antral balloon catheters when treating small and medium size fractures. A significant difference was found in enophthalmos (p < 0.02) and vertical globe position (p < 0.01) between implantation and no treatment at all. While exophthalmos and lifting of the bulbus are more often associated with implantation, enophthalmos and vertical depression of the bulbus may result when no treatment is given. Implantation results in least loss of sensitivity of N. V/2 (49%). In contrast the combination of implantation and antral balloon catheter shows the worst outcome (65%).

CONCLUSIONS

In small and medium fractures best results are achieved when using the antral balloon catheter. However high filling-pressures should be avoided and preferably anatomically shaped catheters used. Implantations are only indicated when treating major fractures. In the presence of possible prion transmission alloplastic or autologous materials should be used. The combination of antral balloon catheters and implants are only indicated in exceptional circumstances, furthermore even in small orbital floor fractures surgical treatment is always indicated.