抄録
We retrospectively analyzed the clinical characteristics of 193 consecutive patients with orbital blowout fracture who consulted us between March 2005 and July 2013. They were 140 males and 53 females ranging in age from 2 to 91 years (average; 36.6 years). About two thirds of patients (122/193=63.2%) were in their teens, twenties and thirties.
There were 87 floor fractures, 56 medial-wall fractures and 50 combined fractures. Seventy-two patients did not show spontaneous improvement of diplopia within the initial follow-up period of 1–2 weeks after injury, and underwent surgery (surgical cases). The other 121 patients were conservatively managed (nonsurgical cases). The percentage of the medial wall fracture was significantly higher in the nonsurgical cases than in the surgical cases (42/121=34.7% vs. 14/72=19.4%, P=0.023). The average interval between injury and surgery was 13.9 days (range; 0–53 days). Endoscopic sinus surgery was performed in the majority of the cases (62/72=86.1%) solely or in combination with the transmaxillary or transorbital approach. Complete recovery was achieved in 41 patients (56.9%), partial recovery in 28 patients (38.9%), and no improvement in 3 patients (4.2%). Patients who reached complete recovery within 1 month were significantly younger than those who did not (25.6±14.0 vs. 38.2±23.1 years, P=0.048). The Hess area ratio at the initial consultation was significantly higher in the nonsurgical cases than in the surgical cases (92.2±13.9 vs. 75.9±21.8%, P<0.001). Patients with complete recovery were likely to have a longer indwelling period of their balloon catheter than those without (6.9±1.3 vs. 6.4±1.1 days, P=0.082). The surgical outcome did not show significant correlation with the interval between injury and surgery.
These results suggest that the indication of surgical treatment for orbital blowout fracture should be determined after the initial follow-up period of 1–2 weeks from injury, taking the patient’s age, type of fracture and Hess area ratio into consideration, unless the extraocular muscle(s) are incarcerated.
