title: Persistent diplopia after fractures involving the orbit related to nerve injury.
abstract: BACKGROUND
  Fractures in the facial skeleton are common and may lead to orbital sequelae caused by the injury and/or the surgery. In this long-term follow-up, we examined the nature of sequelae after facial fractures involving the orbit and whether a higher complexity of the fractures produced more sequelae compared to simpler fracture patterns, and if so, to what extent.
  
  
  METHODS
  Patients surgically treated for facial fractures involving the orbit at the Karolinska University Hospital with a follow-up duration of ≥3 years were included in this retrospective study and were examined by a neuro-ophthalmologist. Based on the location and severity of the fractures, the patients were divided into four groups according to fracture complexity: 1) isolated zygomatic fracture, 2) isolated orbital floor blowout fracture, 3) zygomatic fracture combined with blowout fracture and 4) bilateral or multiple fracture patterns.
  
  
  RESULTS
  Out of 154 patients, 81 patients (53%) attended follow-up examinations, 65 male (80%) and 16 female (20%). The duration of follow-up was 3.0-7.6 years (mean of 4.9 years). The incidence of diplopia was 3.7%, visual loss 2.5%, dystopia 4.9% and visible enophthalmos (>2 mm) 8.6%. Severe diplopia (2.5%) was due to nerve injuries. Visual loss was encountered only in group 4 with complex fractures. Fracture complexity had an effect on the presence of any sequelae, with group 4 presenting a higher percentage of patients with sequelae than the other three groups. However, no statistically significant effect of group could be found on the individual, quantitative output values of dystopia and enophthalmos.
  
  
  CONCLUSIONS
  In this study, severe persistent diplopia in patients was due to nerve injuries, which emphasizes the need for preoperative ophthalmologic examinations, in all patients with fractures involving the orbit. A higher fracture complexity was found to lead to a higher percentage of patients presenting sequelae.
authors.affiliation: Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. Electronic address: erik.neovius@karolinska.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Neovius
authors.affiliation: Department of General Surgery, Sundsvall, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Fransson
authors.affiliation: Department of Ophthalmology, Sankt Erik Hospital, Stockholm, Sweden.
authors.forename: Sköld Peter
authors.initials: SP
authors.lastname: Matthis
authors.affiliation: Materials in Medicine, Applied Materials Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Persson
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Stockholm Craniofacial Center, Department of Oral Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sophie
authors.initials: S
authors.lastname: Östlund
authors.affiliation: Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Filip
authors.initials: F
authors.lastname: Farnebo
authors.affiliation: Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: T Kalle
authors.initials: TK
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D001766:Blindness / Q000209:etiology; D020209:Cranial Nerve Injuries / Q000150:complications*; D004172:Diplopia / Q000209:etiology*; D015841:Enophthalmos / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications*; D012189:Retrospective Studies; D015051:Zygomatic Fractures / Q000150:complications*
keywords: Diplopia; Facial fractures; Long-term follow-up; Nerve injury; Sequelae