Asian Journal of Research in Surgery

The Difference between the Complications of Early Vs. Late Reconstruction in Patients with Traumatic Orbital Fractures

Somar Hassan Ali *

AL Dhannah Hospital, United Arab Emirates.

*Author to whom correspondence should be addressed.

---

Abstract

Traumatic orbital fractures, resulting from facial trauma, can lead to significant aesthetic and functional issues if not managed appropriately. These fractures typically result from blunt force trauma to the face, such as in car accidents, sports injuries, or physical altercations. The orbit is a complex structure formed by several bones, including the frontal, zygomatic, maxilla, and ethmoid bones, which protect and support the eyeball and surrounding structures. When a traumatic orbital fracture occurs, it can cause a range of symptoms and potential complications. Common signs include periorbital swelling, bruising, double vision, and restricted eye movement. In severe cases, the injury can damage the optic nerve, leading to vision impairment. This literature review investigates into the ongoing debate concerning the optimal timing for surgical intervention in these cases, comparing early and late reconstruction. Studies indicate that early reconstruction tends to yield more favorable outcomes. For instance, one study demonstrated that early correction of enophthalmos within one month of injury led to significantly better outcomes, whereas delayed surgery was associated with more severe complications, including tissue fibrosis and atrophy. Factors such as diplopia and enophthalmos were evaluated in patients undergoing surgical treatment for orbital blowout fractures at different time intervals post-injury. The findings revealed that early intervention reduced postoperative diplopia, especially when performed within two weeks of the injury. Similarly, another study focusing on orbital-floor trap-door fractures emphasized the importance of early surgery within eight days of injury, showcasing superior outcomes compared to delayed surgery. A retrospective analysis further suggested that successful fracture repair can be achieved within 29 days following trauma, challenging the notion of a strict 14-day timeframe. In the context of pediatric patients, early intervention was recommended within two weeks for most cases, except for those showing minimal symptoms, where observation and monitoring were deemed appropriate. Overall, the existing literature emphasizes the benefits of early surgical intervention in managing orbital fractures. Timely care within the first two weeks is associated with a higher likelihood of complete recovery of symptoms, lower rates of postoperative diplopia and enophthalmos, and the resolution of motility restriction.

Keywords: Traumatic orbital fractures, early reconstruction, late reconstruction

---

---

---

References

Gafurov Z. Treatment of orbital wall fractures with regard to visual function. World Bulletin of Public Health. 2022;13: 192-8.

Terrill SB, You H, Eiseman H, Rauser ME. Review of ocular injuries in patients with orbital wall fractures: a 5-year retrospective analysis. Clinical ophthalmology. 2020; 2837-42.

Committeri U, Arena A, Carraturo E, Austoni M, Germano C, Salzano G et al. Incidence of orbital side effects in zygomaticomaxillary complex and isolated orbital wall fractures: a retrospective study in south Italy and a brief review of the literature. Journal of Clinical Medicine. 2023;12(3):845.

Kono S, Yokota H, Naito M, Vaidya A, Kakizaki H, Kamei M et al. Pressure onto the orbital walls and orbital morphology in the orbital floor or medial wall fracture: A 3-dimensional printer study. Journal of Craniofacial Surgery. 2023;34(6):e608-e12.

Pitak-Arnnop P, Witohendro LK, Tangmanee C, Subbalekha K, Sirintawat N, Neff A et al. Assessing the effectiveness of endoscope-assisted medial orbital wall fracture repair vs. no surgery using benefit-risk metrics and literature review. Journal of Stomatology, Oral and Maxillofacial Surgery. 2023;124(1):101267.

Christensen DN, Wagner WD, Maar DJ, Shostrom V, Untrauer J, Chundury RV, et al. Orbital Wall Fractures and Ocular Injury: Impact on Management. Facial Plastic Surgery & Aesthetic Medicine. 2023;25(1):22-6.

Abdulkerimov T, Mandra Y, Gerasimenko V, Tzekh D, Samatov N, Mandra E, et al. Frequency of the orbital wall fractures. A retrospective study. Stomatology problems. 2019;15(2):46-9.

Bhate M, Deshmukh A, Bothra N, Kekunnaya R, Badakere A, Sharma A. Clinical profiles and surgical outcomes of strabismus following orbital wall fractures: A large cohort from a tertiary eye care center. Journal of Pediatric Ophthalmology & Strabismus. 2022;59(3):172-9.

Choi A, Sisson A, Olson K, Sivam S. Predictors of delayed enophthalmos after orbital fractures: a systematic review. Facial Plastic Surgery & Aesthetic Medicine. 2022;24(5):397-403.

Piombino P, Troise S, Maglitto F, Barone S, Sani L, Committeri U, et al. Management of orbital floor fractures: Our experience in 10 years. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022;74(4):547-54.

Adam S, Sama HD, Akpoto YM, Bissa H, Agoda P, Foma W et al. Orbital floor fractures: Epidemiological, clinical and therapeutical study at Sylvanus Olympio University teaching hospital in Lomé about 51 Cases. Open Journal of Stomatology. 2021;11(9):373-86.

Mathan JJ, Chandra V. Total traumatic expulsive Iridodialysis with an orbital-floor fracture. Case Reports in Ophthalmology. 2022;13(2):626-9.

Chandra JJMV. Total Traumatic Expulsive Iridodialysis with an Orbital-Floor Fracture; 2022.

Kang YF, Liang J, He Z, Zhang L, Shan XF, Cai ZG. Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73(2):337-43.

Seifert LB, Mainka T, Herrera- Vizcaino C, Verboket R, Sader R. Orbital floor fractures: epidemiology and outcomes of 1594 reconstructions. European Journal of Trauma and Emergency Surgery. 2022;48(2): 1427-36.

Hoşal BM, Beatty RL. Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit. 2002;21(1):27-33.

Yamanaka Y, Watanabe A, Sotozono C, Kinoshita S. Impact of surgical timing of postoperative ocular motility in orbital blowout fractures. Br J Ophthalmol. 2018; 102(3):398-403.

Canto A, Linberg J. Comparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma. Ophthalmic Plastic and Reconstructive Surgery. 2008;24:437-43.

Bera RN, Tiwari P, Pandey V. Does early treatment of paediatric orbital fracture offer any advantage in terms of post-operative clinical outcomes. J Maxillofac Oral Surg. 2022;21(1): 25-33.

Jazayeri HE, Khavanin N, Yu JW, Lopez J, Ganjawalla KP, Shamliyan T et al. Does early repair of orbital fractures result in superior patient outcomes? a systematic review and meta-analysis. J Oral Maxillofac Surg. 2020;78(4):568-77.