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Orbital blowout fracture8/6/2023 ![]() 6 7 The objective of fracture treatment is to reduce displaced soft tissues and restore the preinjury anatomic contour and volume of the bony orbit. 5 6 Anatomic and volumetric changes of the bony orbit most significantly affect globe position and can lead to enophthalmos or hypoglobus. 3 4 Frank muscle entrapment presenting with limited upward gaze and vertical diplopia can also occur but probably does so with less frequency than previously thought. 2 Diplopia is the most common complication and often results from displacement of the fibrous septa that unite the inferior rectus sheath, the fibrofatty tissue, and the periosteum of the orbital floor. Acute signs and symptoms of orbital blowout fractures include orbital pain, enophthalmos, diplopia, and infraorbital nerve hypesthesia. The current definition can include any internal orbital wall fracture, but primarily refers to the floor or medial wall. These fractures correlated clinically with enophthalmos and restricted ocular motility. The orbital “blowout fracture” was initially defined by Smith and Regan 1 in 1957 when cadaver studies showed that traumatic energy from orbital soft-tissue injuries produced predictable orbital floor fractures. In addition, North American trends in postoperative management of orbital blowout fractures may suggest that selected patients can be managed on an outpatient basis, which would have a positive effect on conservation of diminishing healthcare resources. For orbital blowout fractures, the number of immediate postoperative complications at our institution is low. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on an outpatient basis postoperatively ( p = 0.04). Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Average length of stay was 17 hours for those observed overnight. ![]() Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. ![]() A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Orbital fractures are a common result of facial trauma.
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