A consecutive case review of orbital blowout fractures and recommendations for comprehensive management.
BACKGROUND
The orbital blowout fracture is a common facial injury, but full consensus has not been reached regarding its optimal management. The authors retrospectively explored consecutive cases of blowout fractures and proposed new recommendations for treatment.


METHODS
Two hundred eight newly registered patients were selected from the database of Nagasaki University Hospital over the past 5 years. One hundred nine patients in the authors' department were then reviewed regarding computed tomographic classification of fracture types, preoperative complaints, and outcomes.


RESULTS
Of the 208 patients reviewed, 43 underwent surgical repair: 37 for diplopia and 14 for enophthalmos, including eight patients who were treated for both conditions. Regarding floor fractures, the punched-out type fracture was the most common, but the burst type was associated with the highest likelihood of undergoing surgery. For medial wall fractures, the punched-out type dominated, but the overall operative incidence was lower than that observed for the floor fractures. For diplopia, more than half of the operations were performed within 2 weeks, but only two cases were performed within 3 days. For enophthalmos, over 60 percent of operations were carried out after 1 month. Two cases, later discovered to involve muscle strangulation, continued to demonstrate residual diplopia in ordinary use, and two patients continued to show enophthalmos. However, overall outcomes were considered satisfactory.


CONCLUSIONS
If computed tomographic findings disclose a linear fracture with muscular strangulation, urgent surgery must be performed. However, for linear fractures without impaction of the muscle, or punched-out or burst type fractures, close observation for days may be appropriate. In addition, surgical intervention can be performed electively when diplopia persists for several days of observation.
Yano
Hiroki
H
Nagasaki and Hofu, Japan From the Department of Plastic and Reconstructive Surgery, Nagasaki University School of Medicine, and the Department of Plastic Surgery, Yamaguchi Grand Medical Center.
Nakano
Motoi
M
Anraku
Kuniaki
K
Suzuki
Yuichi
Y
Ishida
Hiroyuki
H
Murakami
Ryuichi
R
Hirano
Akiyoshi
A
D002648:Child; D004172:Diplopia / Q000601:surgery; D019468:Disease Management; D015841:Enophthalmos / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009917:Orbital Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed