Long Term Complications of Orbital Floor Fracture Repair

Purpose

To search for complications of orbital floor fracture repair that occur late postoperatively, to reveal their natural course and to attempt to associate the complications with variables that are possibly involved in their genesis.

Methods

A retrospective comparative case series of all orbital floor fracture repair cases (158 eyes) from 1983 to 1998 was done. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction (eg, sinus) was required.

Variables studied included age, sex, trauma to surgery time lag, surgeon, fracture type, length of surgery, antibiotics, prosthesis material, hospital stay and follow-up. These variables were tested for association with the following complications: altered vision, diplopia, dysesthesia, ectropion, pain, infection, enophthalmos and extrusion. Occurrence and resolution data were collected.

Results

One of four complications (often more than one per eye) resolved without surgery. Reintervention resolved one of three complications. Of all patients, 39.2% remain with long term unresolved complications.

Altered vision is more probable with older patients and with longer surgeries. Diplopia was least likely to occur with orbitozygomatic or panfacial fractures and more probable with bone grafts. Ectropion and epiphora increased with a fracture's severity. Pain was mostly attributable to bone grafts. Enophthalmos was mainly due to large or comminuted fractures. Infection and extrusion were rare. Sex, surgeon and trauma to surgery time lag had no bearing on the incidence of complications.

Conclusions

Delaying surgery did not seem to influence complications. Lessening ocular manipulation during longer surgeries may reduce vision changes. The only truly modifiable variable was the material used for orbital floor repair. Alloplastic prostheses should be used, but if large or comminuted fractures are involved, bone grafting is an interesting first choice.