A retrospective study of pure medial orbital wall fracture management

M Alafaleq; F Roul-Yvonnet; T Schouman; P Goudot

doi:10.1016/j.jfo.2019.01.003

A retrospective study of pure medial orbital wall fracture management

J Fr Ophtalmol. 2019 Jun;42(6):592-596. doi: 10.1016/j.jfo.2019.01.003. Epub 2019 May 11.

Authors

M Alafaleq¹, F Roul-Yvonnet², T Schouman³, P Goudot²

Affiliations

¹ Service de chirurgie maxillo-faciale et stomatologie, AP-HP, hôpital Pitié-Salpêtrière, 75013, Paris, France; Sorbonne Université, UPMC université Paris 06, 75005, Paris, France. Electronic address: monira-afaleq@hotmail.com.
² Service de chirurgie maxillo-faciale et stomatologie, AP-HP, hôpital Pitié-Salpêtrière, 75013, Paris, France; Sorbonne Université, UPMC université Paris 06, 75005, Paris, France.
³ Service de chirurgie maxillo-faciale et stomatologie, AP-HP, hôpital Pitié-Salpêtrière, 75013, Paris, France.

PMID: 31088740
DOI: 10.1016/j.jfo.2019.01.003

Abstract

Purpose: To describe the clinical presentation of isolated medial orbital wall fractures, the duration of symptoms and their management.

Methods: Retrospective study of 60 orbits of 60 patients over 18 years of age with isolated medial wall fractures of the orbit at the facial and trauma center of the Pitié-Salpêtrière university hospital of Paris between June 2012 and November 2015. Diplopia, enophthalmos and limitation of extraocular muscle movements were investigated. The location of the fractures was confirmed with three-dimensional computed tomography. Intraocular trauma was ruled out. Incomplete data were excluded.

Results: Eighty-three patients were identified (June 2012-November 2015). Sixty patients (39 males and 21 females) had a complete medical record. The mean age was 37 years, ranging from 18 to 75 years. Assault was the most common cause in 45 patients (75%), followed by sports accidents in 8 patients (13%), motor vehicle accidents in 6 patients (10%), and a fall in 1 patient. On presentation, 51 patients (85%) had no symptoms. Diplopia was present in 9 patients (15%). Four of them (6.7%) had associated enophthalmos. The diplopia resolved spontaneously in 5 patients (5.5%) and persisted more than 2 weeks in 4 patients (6.7%), for whom surgical intervention was recommended. Only 4 patients (6.7%) were managed surgically due to the presence of combined persistent diplopia and enophthalmos. The mean time from trauma to surgery was 18 days (15-45 days). At the 45-day postoperative follow-up, persistent diplopia was present in 1 patient out of the four treated surgically, with no residual enophthalmos. Fifty-six patients were managed conservatively.

Conclusion: Asymptomatic fractures do not require surgical repair, and conservative management is adequate. Such fractures heal on their own without any consequences.

Keywords: Diplopia; Diplopie; Enophtalmie; Enophthalmos; Fractures Orbitaires; Medial wall; Orbital fractures; Paroi interne; Trauma; Traumatisme.

MeSH terms

Accidents, Traffic
Adult
Aged
Aged, 80 and over
Athletic Injuries / complications
Diplopia / diagnosis
Diplopia / etiology*
Enophthalmos / diagnosis
Enophthalmos / etiology*
Female
Humans
Imaging, Three-Dimensional / methods
Male
Middle Aged
Oculomotor Muscles
Ophthalmoplegia / etiology
Orbital Fractures / complications*
Orbital Fractures / diagnostic imaging
Retrospective Studies
Symptom Assessment / methods
Time-to-Treatment
Tomography, X-Ray Computed / methods
Violence / statistics & numerical data