Abstract
Orbital fractures can result in devastating functional complications to sight and
well-being, yet our understanding of functional sequelae post reconstruction is not
well understood in the literature. This research retrospectively analysed the activity
of a specialist orbital surgeon over five years to evaluate the incidence of, and
risk factors for, debilitating complications such as diplopia and restriction of extraocular
movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019
were retrospectively analysed. Demographics, orthoptic assessment, injury classification,
timing, operative details, outcomes, and complications were recorded. Preoperative
and postoperative binocular single vision scores (BSV) were recorded to calculate
the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital
access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria,
of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had
diplopia, and 5.7% were returned to theatre. All those with residual diplopia had
had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery,
material, and pure orbital fractures had a significant impact on the incidence of
diplopia. Defect size did not. Whilst complication rates were low we conclude that
strict adherence to a defined surgical protocol, postoperative imaging, and objective
assessment of postoperative function are central to maintaining these standards. Objective
orthoptic analysis of patients before and after orbital repair is critical to our
understanding of this pathology. Whilst preoperative prediction of the persistence
of long-term diplopia currently eludes us, further research should target it.
Keywords
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Article info
Publication history
Published online: January 31, 2023
Accepted:
January 24,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
