title: Evolving trends in the management of orbital floor fractures.
abstract: 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 manage orbital floor fractures. The results are summarized and compared with a 10-year literature review (2002-2012) 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 participants 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 restriction, 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 preferred implants (83%) compared with autologous bone (5%).
  
  
  CONCLUSIONS
  Significant interdisciplinary and intradisciplinary differences in the management of orbital fractures exist. The most significant 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.
authors.affiliation: 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 University, New Orleans, Louisiana.
authors.forename: Salah
authors.initials: S
authors.lastname: Aldekhayel
authors.forename: Hattan
authors.initials: H
authors.lastname: Aljaaly
authors.forename: Omar
authors.initials: O
authors.lastname: Fouda-Neel
authors.forename: Abdul-Wahab
authors.initials: AW
authors.lastname: Shararah
authors.forename: Waleed Suliman
authors.initials: WS
authors.lastname: Zaid
authors.forename: Mirko
authors.initials: M
authors.lastname: Gilardino
mesh_terms: D064592:Autografts / Q000637:transplantation; D001672:Biocompatible Materials / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D002170:Canada; D004172:Diplopia / Q000150:complications; D015841:Enophthalmos / Q000150:complications; D005133:Eye Movements / Q000502:physiology; D006801:Humans; D015835:Ocular Motility Disorders / Q000150:complications; D009885:Ophthalmology / Q000193:education; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery*; D010036:Otolaryngology / Q000193:education; D010347:Patient Care Planning; D011095:Polyethylenes; D019651:Plastic Surgery Procedures / Q000379:methods*; D013515:Surgery, Oral / Q000193:education; D013518:Surgery, Plastic / Q000193:education; D013997:Time Factors; D014025:Titanium
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; C084562:Medpor; D011095:Polyethylenes; D014025:Titanium