Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation

BACKGROUND
A common consent regarding repair indications, timing of repair and choice of reconstruction materials for isolated orbital base fractures does not yet exist.
METHODS
We retrospectively reviewed our patients (41 male, 13 female) who were operated due to a diagnosis of isolated orbital floor fracture between 2002 and 2010.
RESULTS
Fifty-four patients diagnosed with isolated orbital base fracture were found; 49 of 54 patients required surgery. The indications for surgery were restricted ocular motility and marked enophthalmos in 20.4% of the patients, whereas in 79.6%, surgical intervention was decided largely based on the coronal computed tomography images. 36.7% of the cases were operated earliest, in the first 16 hours, and 10.2% were operated the latest, in 72-96 hours. Ultra-thin porous polyethylene was used in the orbital base repair. Twelve patients contacted for this study were evaluated. Enophthalmia and exophthalmia were in normal limits in patients, and none of the patients displayed ectropion or scleral show findings or reported any complaints related to scar formation.
CONCLUSION
When not treated in a timely manner and with appropriate materials, orbital base fractures might result in enophthalmia and diplopia. We believe that a good prognosis of orbital base fractures relies on the right decision for surgical indication, early surgical intervention, and repair with appropriate material.

Ýzole orbita tabaný kýrýklarýna klinik yaklaþým ve ameliyat öncesi deðerlendirmede bilgisayarlý tomografinin rolü

AMAÇ
Ýzole orbita taban kýrýklarýnýn cerrahi endikasyonu, zamanlamasý, kullanýlacak rekonstrüksiyon materyali hakkýnda halen görüþ birliði yoktur.
GEREÇ VE YÖNTEM
2002-2010 yýllarý arasýnda izole orbita taban kýrýðý tanýsý alarak ameliyat edilen hastalar (41 erkek, 13 kadýn) geriye dönük olarak deðerlendirildi.
BULGULAR
Ýzole orbita taban kýrýðý tanýsý alan 54 hastadan, ameliyat edilen 49 hastanýn cerrahi endikasyonuna bakýldýðýnda, %20,4’ünde göz hareketlerinde kýsýtlýlýk ve belirgin enoftalmi, %79,6’sýnda koronal planda çekilen bilgisayarlý tomografi görüntülerinin etkili olduðu görüldü. Hastalarýn %36,7’si ilk 16 saat içinde %10,2’si en geç 72-96 saat içinde ameliyat edildi. Orbita taban onarýmý için ultra ince poröz polyetilen kullanýldý. Bu çalýþma nedeniyle kendilerine ulaþýlan 12 hastanýn enoftalmi-egzoftalmi açýsýndan normal sýnýrlarda olduðu, hiçbir hastada ektropiyon ya da skleral show bulgusu olmadýðý, hastalarýn skara baðlý herhangi bir þikayetlerinin olmadýðý görüldü.
SONUÇ
Tedavi edilmediðinde enoftalmi ve çift görme ile sonuçlanabilecek olan orbita taban kýrýðýnda, iyi prognoz doðru cerrahi endikasyon, erken cerrahi giriþim ve uygun materyal ile onarýma baðlý olduðunu düþünmekteyiz.