Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Factors Associated With Surgical Outcomes in Medial Orbital Wall Fracture Reconstruction With Absorbable Plates.
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Li Bei
Аннотация
BACKGROUND: Preoperative imaging factors associated with absorbable plate reconstruction outcomes for medial orbital wall fractures are not well-established. The role of muscle cone integrity on computed tomography (CT) has not been systematically evaluated.
PURPOSE: To evaluate the association between muscle cone integrity and surgical outcomes.
STUDY DESIGN, SETTING, SAMPLE: Retrospective cohort study at Chengdu First People's Hospital (2020 to 2023) including adults with isolated medial orbital wall fractures treated with an absorbable plate.
EXCLUSION CRITERIA: trapdoor fractures, additional orbital wall fractures, severe globe rupture, or pre-existing orbital pathology.
PREDICTOR VARIABLE: Muscle cone integrity on preoperative CT: intact (no intraconal emphysema) versus disrupted (significant intraconal emphysema).
MAIN OUTCOME VARIABLE(S): The primary outcome variable was surgical outcome, coded as satisfactory or unsatisfactory based on binocular proptosis difference on 1-year CT: satisfactory = no significant difference between affected and healthy eyes (P ≥ .05); unsatisfactory = significant difference (P < .05). Maximum medial and lateral rectus muscles (MR-LR) distance was a secondary outcome.
COVARIATES: Age, sex, vision, presence of preoperative diplopia or limited eye movement, degree of enophthalmos, and size of the orbital wall defect.
ANALYSES: Normality was assessed using the Shapiro-Wilk test. Within-group comparisons were performed using the paired t-test or Wilcoxon signed-rank test, between-group comparisons using the independent-samples t-test, Mann-Whitney U test, or Fisher's exact test as appropriate. Significance was set at P < .05.
RESULTS: 36 subjects were included: 29 (80.6%) intact and 7 (19.4%) disrupted. In the intact group, preoperative differences in proptosis (P = .04) and MR-LR distance (P < .001) resolved postoperatively, achieving satisfactory outcomes (both P = .1). In the disrupted group, significant preoperative differences (proptosis: P = .03; MR-LR: P < .001) persisted postoperatively, yielding unsatisfactory outcomes (proptosis: P = .02; MR-LR: P = .02).
CONCLUSIONS AND RELEVANCE: Within the limitations of this study, preoperative muscle cone integrity on CT is associated with outcomes in medial orbital wall reconstruction. In patients with an intact muscle cone, the use of absorbable plates was associated with satisfactory restoration of proptosis and intermuscular distance. Disruption, indicated by intraconal emphysema, correlated with suboptimal correction, suggesting that muscle cone disruption may represent an important prognostic factor for surgical outcomes.
PURPOSE: To evaluate the association between muscle cone integrity and surgical outcomes.
STUDY DESIGN, SETTING, SAMPLE: Retrospective cohort study at Chengdu First People's Hospital (2020 to 2023) including adults with isolated medial orbital wall fractures treated with an absorbable plate.
EXCLUSION CRITERIA: trapdoor fractures, additional orbital wall fractures, severe globe rupture, or pre-existing orbital pathology.
PREDICTOR VARIABLE: Muscle cone integrity on preoperative CT: intact (no intraconal emphysema) versus disrupted (significant intraconal emphysema).
MAIN OUTCOME VARIABLE(S): The primary outcome variable was surgical outcome, coded as satisfactory or unsatisfactory based on binocular proptosis difference on 1-year CT: satisfactory = no significant difference between affected and healthy eyes (P ≥ .05); unsatisfactory = significant difference (P < .05). Maximum medial and lateral rectus muscles (MR-LR) distance was a secondary outcome.
COVARIATES: Age, sex, vision, presence of preoperative diplopia or limited eye movement, degree of enophthalmos, and size of the orbital wall defect.
ANALYSES: Normality was assessed using the Shapiro-Wilk test. Within-group comparisons were performed using the paired t-test or Wilcoxon signed-rank test, between-group comparisons using the independent-samples t-test, Mann-Whitney U test, or Fisher's exact test as appropriate. Significance was set at P < .05.
RESULTS: 36 subjects were included: 29 (80.6%) intact and 7 (19.4%) disrupted. In the intact group, preoperative differences in proptosis (P = .04) and MR-LR distance (P < .001) resolved postoperatively, achieving satisfactory outcomes (both P = .1). In the disrupted group, significant preoperative differences (proptosis: P = .03; MR-LR: P < .001) persisted postoperatively, yielding unsatisfactory outcomes (proptosis: P = .02; MR-LR: P = .02).
CONCLUSIONS AND RELEVANCE: Within the limitations of this study, preoperative muscle cone integrity on CT is associated with outcomes in medial orbital wall reconstruction. In patients with an intact muscle cone, the use of absorbable plates was associated with satisfactory restoration of proptosis and intermuscular distance. Disruption, indicated by intraconal emphysema, correlated with suboptimal correction, suggesting that muscle cone disruption may represent an important prognostic factor for surgical outcomes.