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Reprinted by permission of J Craniofac Surg. 2014; 25(1):258-261.

O RIGINAL A RTICLE

Evolving Trends in the Management of Orbital Floor Fractures Salah Aldekhayel, MD, MEd,* Hattan Aljaaly, MD,* Omar Fouda-Neel, MD, FRCSC,* Abdul-Wahab Shararah, MD, PharmD,* Waleed Suliman Zaid, DDS, MSc, Þ and Mirko Gilardino, MD, MSc*

Conclusions: Significant interdisciplinary and intradisciplinary dif- ferences in the management of orbital fractures exist. The most sig- nificant trends are the growing popularity of alloplastic versus autogenous materials for orbital floor reconstruction and the fact that one-third of surgeons are more likely to opt for a nonoperative (conservative) approach compared with earlier in their careers. Key Words: Orbit fractures, facial fractures, Canadian Society of

Background: The management of orbital floor fractures is diverse and continues to evolve. The purpose of the current study was to provide an updated summary of the literature, with a focus on interspecialty differences, and contrast that with current treatment strategies of actively practicing plastic surgeons. Methods: A survey was conducted of surgeons who currently man- age orbital floor fractures. The results are summarized and compared with a 10-year literature review (2002 Y 2012) of surgical approaches, indications and timing of surgery, and implant selection in various surgical disciplines. Inclusion criteria included studies in English language with 10 or more patients. Results: The survey response rate was 56%, of which 86 surgeons were identified to currently manage orbit fractures. A third of par- ticipants reported they are less likely to operate on these fractures relative to earlier in their career. Six factors were found to have the greatest influence on surgeon’s operative decision: enophthalmos, hypophthalmos, positive forced duction, defect size, motility restric- tion, and persistent diplopia. The most common preferred approach to the orbit is midlid/infraorbital (45%) followed by transconjunctival (31%) and subciliary (24%). Medpor and titanium are the most pre- ferred implants (83%) compared with autologous bone (5%).

Plastic Surgeons, implants, biomaterials ( J Craniofac Surg 2014;25: 258 Y 261)

T he treatment of orbital floor fractures continues to evolve. Sur- geons must make choices regarding the approach, the material used to reconstruct the orbit floor, and, importantly, the indication and timing of surgical intervention. Adding to the variety of surgi- cal techniques is the fact that orbit fractures are managed by various surgical specialties including plastic surgery, oral and maxillofacial surgery (OMFS), otolaryngology (ENT), and ophthalmology. While the goal of treatment is always the restoration of orbital form and function, the diversity in surgical training, specialty-specific trends, and even surgeons’ personal experience contribute to the variability by which it is achieved. The purpose of the current study was to present an updated literature review of the surgical trends in orbital floor fracture man- agement, with specific focus on the differences between surgical specialties. 1 Y 8 The authors also aimed to provide the most current treatment strategies by way of a focused survey of actively practicing plastic surgeons who perform these repairs and contrast these trends with the literature and historical patterns. Ultimately, such informa- tion may provide useful feedback that allows surgeons to compare their current treatment strategies with that of their interdisciplinary and intradisciplinary surgical colleagues. A PubMed MEDLINE literature search was performed to identify clinical studies reporting the management of orbital floor fractures. Studies with 10 or more patients, published in English language between 2002 and 2012, were included. Parameters col- lected were timing of surgery, indications for operative intervention, types of material used for orbital floor reconstruction, and incision utilized. Results were classified according to specialty: plastic sur- gery, ENT, ophthalmology, and OMFS. Survey A survey was developed to identify eligible candidates who currently manage orbit fractures. Respondents who do not routinely MATERIALS AND METHODS Literature Review

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From the *H. Bruce Williams Craniofacial and Cleft Surgery Unit, Montreal Children’s Hospital, and Division of Plastic & Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada; and † Department of Oral and Maxillofacial Surgery, Louisiana State Uni- versity, New Orleans, Louisiana Received July 22, 2013. Accepted for publication September 17, 2013. Address correspondence and reprint requests to Mirko Gilardino, MD, MSc, FRCSC, FACS, H. Bruce Williams Craniofacial and Cleft Surgery Unit, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal Children’s Hospital, 2300 Tupper St, C11.33, Montreal, Quebec, Canada H3H 1P3; E-mail: mirko.gilardino@muhc.mcgill.ca Presented at the 67th Annual Meeting of the Canadian Society of Plastic Surgeons, in Calgary, Alberta, Canada, May 28 to June 1, 2013.

The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000441

The Journal of Craniofacial Surgery & Volume 25, Number 1, January 2014

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