Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

Shahrooz S Kelishadi; Matthew R Zeiderman; Karan Chopra; Joseph A Kelamis; Gerhard S Mundinger; Eduardo D Rodriguez

doi:10.1055/s-0038-1641172

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

Craniomaxillofac Trauma Reconstr. 2019 Mar;12(1):39-44. doi: 10.1055/s-0038-1641172. Epub 2018 Mar 30.

Authors

Shahrooz S Kelishadi¹, Matthew R Zeiderman², Karan Chopra³, Joseph A Kelamis⁴, Gerhard S Mundinger⁵, Eduardo D Rodriguez⁶

Affiliations

¹ SSK Plastic and Reconstructive Surgery, Newport Beach, California.
² Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, California.
³ Section of Plastic Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
⁴ Section of Plastic Surgery, Mercy Clinic in Fort Smith, Fort Smith, Arkansas.
⁵ Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
⁶ Department of Plastic Surgery, New York University Langone Medical Center, New York.

Abstract

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.

Keywords: blindness; craniofacial trauma; facial fractures; fracture pattern; traumatic optic neuropathy.