Patterns of Orbital Fractures Needing Surgical Reconstruction in a Large Tertiary Hospital in Northern India. (31st March 2021)

• Record Type: Journal Article
• Authors: Gupta, Sneha; Singh, Praveen Kumar; Mehrotra, Divya; Mohammad, Shadab; Singh, Vibha; Kaur, Apjit; Ojha, Bal Krishna
• Is Part Of: Craniomaxillofacial trauma & reconstruction open. Volume 6(2021)
• Publication Date: 2021-03-31
• Subjects: orbital floor injury -- orbital floor fracture -- orbital floor reconstruction -- reconstruction materials; Face -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Head -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; 617.51
• DOI: 10.1177/2472751221999163
• Languages: English
• ISSNs: 2472-7512

Abstract

Study Design: This is a prospective study for 3 year duration. Objective: The aim of this study was to observe the incidence and patterns of orbital fractures and discuss their treatment options. Methods: A total 29604 trauma patients visited our emergency department within May 2017 to Oct 2019, where 1230 (4.15%) patients presented with orbital fractures, of which only 44 (3.6% of orbital fracture) patients required surgical reconstruction, and were enrolled in our study and evaluated for their fracture patterns, size of bone defect, clinical presentation, timing of surgery, reconstruction, and complications. Results: The incidence of orbital fracture was 4.15%, of which only 20.5% were pure blow out. Associated fractures included 72.7% zygomatic complex, 50% LeFort, 31.8% mandible and 20.5% pan facial fractures. The most common pattern was the 1 wall orbital defect in 38.6%, 2 wall in 27.3%, 3 wall in 29.5% and 4 wall in 4.5%. The orbital floor fracture was seen in 100%, medial wall in 27.3%, lateral wall in 61.4%, roof in 15.9%. Different reconstruction options used included calvarial bone (2.3%), ear cartilage (2.3%), medpore (36.4%), polycaprolactone sheet (6.8%), titanium mesh (52.3%), patient specific implant (6.8%) and navigation (4.5%). Conclusion: Orbital fractures are mostly impure fractures, associated with zygomatic complex fractures, hence lateral wall fractures are seen more commonly. Patient specific implants, navigation guided reconstruction, autologous calvarial bone graft and preformed titanium mesh show better results, and fulfill the objectives of orbital reconstruction by restoring the normal anatomy and volume of the orbit.