title: Influence of the volume of soft tissue herniation on clinical symptoms of patients with orbital floor fractures.
abstract: BACKGROUND
  One of the most important complications of orbital floor fractures is diplopia and restricted ocular movement. The role of the volume of soft tissue herniation on these clinical symptoms after orbital floor fractures is unclear and potentially may predict development of persistent clinical symptoms. Therefore the aim of this study was to assess pre- and postoperative complications associated to the volume of soft tissue herniation, with special interest to diplopia and bulbus motility impairment.
  
  
  METHODS
  204 untreated patients with orbital floor fractures from 2009 to 2011 were included in this retrospective study. Contingency tables and χ2-test were performed to analyze associations between two qualitative variables. p-Values p < 0.05 were considered as significant. Volume measurement was performed in a semiautomatic segmentation method with the software "ITK-Snap".
  
  
  RESULTS
  The volume of soft tissue herniation correlated significantly with pre- and postoperative diplopia (p = 0.003; p = 0.002), persistent diplopia (p = 0.009) as well as pre- and postoperative bulbus motility impairment (both p < 0.001). Furthermore we found out significant associations between the volume of soft tissue herniation and pre- and postoperative complications depending on fracture type and reconstruction technique.
  
  
  CONCLUSIONS
  Volume measurement of soft tissue herniation may help to predict postoperative complications, particularly bulbus motility restriction and persistent diplopia. The risk for these symptoms rises with increasing volume of soft tissue herniation after orbital floor fractures. Therefore we recommend for these patients within indication an early repair and/or closer observation.
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany. Electronic address: asafi@outlook.de.
authors.forename: Ali-Farid
authors.initials: AF
authors.lastname: Safi
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Marie-Theres
authors.initials: MT
authors.lastname: Richter
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rothamel
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nickenig
authors.affiliation: Department for Oral and Maxillofacial Surgery, Johannes-Wesling Krankenhaus, Mühlenkreiskliniken Minden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scheer
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Zöller
authors.affiliation: Department for Oral and Maxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kreppel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D054893:Cone-Beam Computed Tomography; D004172:Diplopia / Q000209:etiology; D005260:Female; D006547:Hernia / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology; D009917:Orbital Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Clinical symptoms; Orbital floor fractures; Segmentation; Soft tissue herniation