Are Persistent Post-traumatic Complications Associated With Orbital Volume Variation After Orbital Reconstruction? A Prospective Cohort Study

Abstract

Background: Orbital fractures are common facial injuries that may cause lasting functional and esthetic complications, but the link between orbital volume variation and persistent postoperative outcomes remains unclear.

Purpose: The study purpose was to measure the association between postoperative orbital volume and persistent postoperative complications.

Study design, setting, and sample: This prospective cohort study was conducted between 2022 and 2024 at the General Hospital of Nova Iguaçu, Brazil. It included patients who underwent surgical treatment of unilateral orbital fractures with orbital wall repair using titanium mesh; those with prior orbital surgery, neurological disorders, facial syndromes, or unsatisfactory reconstruction were excluded.

Predictor variable: The predictor variable was postoperative orbital volume variation defined as the difference between the reconstructed and the contralateral orbit.

Outcome variables: The primary outcome was the persistence of postoperative complications, defined as the presence of enophthalmos, diplopia, ocular dystopia, hypoglobus, superior orbital fissure syndrome, ophthalmoplegia, or retrobulbar hematoma at postoperative follow-up. The secondary outcome was orbital volume variation over time measured at 3 distinct time points.

Covariates: The Covariates analized were age, sex, race, mechanism of injury, fracture side, associated fractures, preoperative complications, orbital defect classification, and follow-up duration.

Analyses: Continuous data were analyzed with Student's t-test or Mann-Whitney U test, and categorical data with Fisher's exact test. Logistic regression identified predictors of persistent complications (odds ratio, 95% CI). Repeated-measures analysis of variance evaluated orbital volume changes over time. Statistical significance was set at P < .05.

Results: This study included 28 subjects, with a mean age of 30.4 years (±10.7), of whom 20 (71.4%) were male. No significant associations were found between orbital volume variation and the analyzed covariates. A statistically significant association was observed only for fracture side (P < .01). Fracture side was the only significant predictor (odds ratio = 6.0; 95% CI, 1.1 to 33.2; P < .01). Repeated-measures analysis of variance showed a significant decrease in orbital volume over time (P < .01).

Conclusions and relevance: Although orbital volume decreased significantly over time, it was not associated with persistent postoperative complications. Outcomes likely reflect multifactorial interactions of trauma severity, surgical treatment, and healing rather than isolated volumetric changes.