Orbital Volume Restoring Surgery of the Inferomedial Blow-out Fracture.

Purpose

The goals of surgically managing orbital blow out fractures are to restore the function and cosmesis of pre-traumatic status, as closely as possible. Conventionally, the orbital wall is often reconstructed with synthetic material without bony reduction (It’s named ‘Conventional surgery’). In contrast, the fractured orbital wall was restored to the pre-traumatic position with the assistance of transnasal reduction by passing the elevator through the ethmoidal or maxillary sinuses (It’s called ‘Orbital volume restoration surgery’). The aim of the present study was to compare the outcomes of orbital volume restoration surgery with of conventional surgery in pure blow out fractures.

Methods

Ninety patients with pure blow out fractures who underwent surgical reconstruction from March 2007 to February 2012 were enrolled. Patients were categorized into three groups in each surgical technique, depending on the anatomical location of the fracture based on a facial CT scan : Inferior (Group I), Inferior Medial (Group IM), Medial (Group M) orbital wall fracture. The orbital volume and the orbital volume ratio were prospectively measured before and 6 months after the surgery with the use of three dimensional CT scans, and Hertel scale was measured with a Hertel exothalmometer.

Results

The orbital volume ratio was decreased by average of 1.70% (Group I), and 3.66% (Group IM), 1.05% (Group M) in conventional surgery, compare with 9.47% (Group I), 11.49% (Group IM), 5.92% (Group M) in orbital volume restoration group (p < 0.05). The changes in Hertel scale were 0.20 mm in conventional group, and 0.23 mm in orbital volume restoration surgery group. However, it was statistically insignificant the difference in Hertel scale (p > 0.05).

Conclusions

 The orbital volume restoration surgery results in better outcome than conventional method in terms of restoring of original orbital volume and restoring of the fractured orbital wall to prior the anatomic position in all groups. Therefore, orbital volume restoration method can be considered as a useful surgical procedures in restoring the pure blow out fractures than conventional procedures.