Page 116 - Advanced concepts in orbital wall fractures
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Chapter 6
Discussion
This prospective cohort study showed promising results for the nonsurgical management of orbital blow-out fractures in a multidisciplinary setting. The purpose of this study was to evaluate a well-defined clinical protocol for orbital floor and/or medial wall fractures. The authors hypothesised that emphasis on nonsurgical management based on orthoptic evaluation would result in good clinical outcome. The first study that presented follow-up of patients with and without surgical repair was in 19711. There was no significant difference in enophthalmos or persistent diplopia in both groups. Since then several authors propagated a nonsurgical approach2-4,6,7,20. Studies have demonstrated significant bias resulting from different treatment approaches, with variations evident across countries, hospitals, and even specialists9,10,48. The aim of this prospective cohort study was to move further towards a standardised treatment protocol based on clinical evidence.
The patient characteristics were similar to those in other studies, with the study population being a representative sample of the general population18,21,49. Most patients (79 %) had no surgery, based on the predetermined criteria in the protocol, which was in line with the emphasise on a nonsurgical approach. Both location and severity of the fractures were comparable across the nonsurgical and surgical groups.
The results in the nonsurgical group were promising. All patients had an excellent, good, or acceptable outcome at the end of follow-up. There were several large fractures in the nonsurgical group (Fig. 3) that might have had an indication for surgery with earlier clinical protocols, but now appeared to recover completely without enophthalmos. The outcome of this study does not support the principles of defect-driven treatment to prevent enophthalmos.





























































































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