Lateral Orbital Wall Fracture: New Classification and Clinical Importance

Kim, Jeong Chul; Ahn, Hee Chang; Kim, Ing Gon; Lew, Jai Mann

Abstract

The purpose of this study is to propose a new fracture classification of lateral orbital wall, to emphasize the clinical significance of lateral orbital wall fractures, and to suggest appropriate surgical approach according to our classification. This study is based on a treatment of forty-seven patients with lateral orbital wall fractures, and medical records and radiologic studies were reviewed retrospectively. A clinical classification was based on radiographs obtained. Grade I fracture is a fracture of the frontal process of the zygoma at the zygomatico-sphenoidal suture line. Grade I fractures are further divided into 2 subgroups: Grade IA-compressed; Grade IBa-laterally displaced fracture; Grade IBb-medially displaced fracture. Grade II fractures are fractures that extend to the orbital plate of the greater wing of the sphenoid. These fractures are further divided: Grade IIA-compressed; and Grade IIB-displaced fracture. In Grade III fractures, the entire greater wing of the sphenoid is impacted toward the orbital apex with possible intrusion into the middle cranial fossa. The most common type of fracture was Grade IBa (51%) and the least common type was Grade IIA (4%). All Grade II and Grade III fractures had major ophthalmic problems. Nineteen of 47cases (40%) developed ophthalmic problems such as proptosis (23%), diplopia (21%), restricted extraocular muscle movement (15%), displacement of eye globe (15%), optic nerve injury (4%), and globe rupture(4%). Postsurgical sequelae included proptosis (4%), diplopia (4%), restricted extraocular muscle movement (6%) and blindness (6%). Our classification can be applied to all types of lateral orbital wall fractures. Our data and analysis demonstrate that Grade II/III fractures have a significant of major and sometimes devastating ophthalmic injuries. These findings, we believe, mandate that all patients with clinically suspected lateral wall fractures obtain a thorough ophthalmologic examination and complete facial CT scans. This classification may be helpful for the diagnosis and treatment of lateral orbital wall fracture.