Effects of the site and the extent of blowout fracture on enophthalmos and diplopia

Hwang, Ung; Ryu, Sun Youl

Abstract

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55+/-1.25cm2 and the volume of the herniated orbital tissue was 1.74+/-0.97cm3 for less than 2mm enophthalmos, 1.43+/-0.99cm3 and 0.52+/-0.49cm3, respectively. The enophthalmos of 2mm can be expected with 2.92cm2 of the fracture area and 1.40cm3 of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is 2.92cm2 or more, or the volume of herniated orbital tissue is 1.40cm3 or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.