HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Reprinted by permission of J Craniomaxillofac Surg. 2018; 46(9):1550-1554.

Journal of Cranio-Maxillo-Facial Surgery 46 (2018) 1550 e 1554

Contents lists available at ScienceDirect

Journal of Cranio-Maxillo-Facial Surgery

journal homepage: www.jcmfs.com

Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital fl oor fractures Gesche Frohwitter a , Stephan Wimmer b , Carolin Goetz b , Jochen Weitz b , Michael Ulbig c , Karsten U. Kortuem d , e , Julia Dangelmaier f , Lucas Ritschl b , Christian Doll g , Oliver Ristow h , Marco R. Kesting a , Steffen Koerdt g , * a Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University, Glückstrasse 11, D-91054, Erlangen, Germany b Department of Oral and Maxillofacial Surgery, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675, Munich, Germany c Department of Ophthalmology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675, Munich, Germany d Moor fi elds Eye Hospital, NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK e University Eye Hospital Munich, Ludwig-Maximilians-University (LMU), Mathildenstr. 8, D-80336, Munich, Germany f Department of Diagnostic and Interventional Radiology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675, Munich, Germany g Charite - Universit € atsmedizin Berlin, corporate member of Freie Universit € at Berlin, Humboldt-Universit € at zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Germany h Department of Oral and Maxillofacial Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany

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Article history: Paper received 29 December 2017 Accepted 25 June 2018 Available online 11 July 2018

Introduction: Treatment decisions for fractures of the orbital fl oor are based on clinical appearance, ophthalmological examination, and computed tomography (CT) scans. In extensive fractures, decisions are easily made between conservative and surgical treatment. However, objective parameters are rare in inconclusive cases. Materials and methods: Our retrospective study included 106 patients with unilateral isolated orbital fl oor fractures. Correlations between preoperative ophthalmological examinations and speci fi c CT pa- rameters were performed. Results: The defect size of the fracture appeared to be signi fi cantly associated with the presence of diplopia. CT-morphological parameters and preoperative ophthalmological results showed statistical signi fi cance for diplopia and incarceration of inferior rectus muscle (IRM), diplopia and displacement of IRM, decreased mobility and incarceration of IRM, and decreased mobility and displacement of IRM. Discussion: Our clinical assessment scheme for CT scans of orbital fl oor fractures is aimed at facilitating treatment decision making using four CT-based variables. As critical size defects of the orbital fl oor of 2 cm 2 are likely to cause clinically signi fi cant posterior displacement of the globe, resulting in enophthalmos, the proposed parameters offer a readily accessible and easy to evaluate scheme that helps to identify patients in need of surgical intervention. © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Keywords: Orbital fl oor Midface fracture Computed tomography Diplopia

1. Introduction

surgical intervention is based on clinical assessment and on the evaluation of radiological imaging such as computed tomography (CT) or conventional X-rays. CT scans are considered to be the gold standard for primary radiological diagnostics of mid-facial trauma, including orbital fracture. Nevertheless, surgical indication is based on algorithms driven by individual standards that lack de fi nitive thresholds for clinical and radiological assessment. Loss of vision and preoperative diplopia are considered to be the most important clinical prognostic factors ( Tahiri et al., 2010 ). Schouman et al. have shown that the severity of inferior rectus muscle displacement is the most important independent

Orbital fractures are considered to be among the most common facial injuries. They can be subdivided into: (i) orbital fractures related to zygomatic fractures; (ii) isolated orbital blow-out or blow-in fractures (IOFF); or (iii) fractures occurring as part of pan- facial trauma ( Ellis et al., 1985 ). Decision making with regard to

* Corresponding author. Charite e Universit € atsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany. Fax: þ 49 30 4507 5559 29. E-mail address: steffen.koerdt@charite.de (S. Koerdt).

https://doi.org/10.1016/j.jcms.2018.06.016 1010-5182/ © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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