Page 108 - Advanced concepts in orbital wall fractures

Chapter 6
Surgical group
The indication and timing of surgery depended on the parameters outlined earlier. In all cases surgical access was via a transconjunctival approach, with or without canthotomy. Orbital defects were reconstructed using titanium implants. Any deviation, being either circumstantial or surgeon-related, was recorded. The surgeons in both hospitals were experienced in, and familiar with, all techniques used. An intraoperative or postoperative CT scan was made before discharge to check the reconstruction. A postoperative clinical examination was carried out by the oral and maxillofacial surgeon before discharge. A control visit was scheduled within 10-14 days and at 6 weeks (± 7 days) after surgery. Further postoperative follow-up visits were scheduled identically to those for the nonsurgical group. If patients had persistent diplopia, enophthalmos, or other severe complications after surgery, a revision surgery could be indicated and was recorded if applicable. Persistent diplopia or unimproved ductions were recorded as these could lead to secondary intervention with an adhesiolysis and/or strabismus surgery.
Study variables
The primary outcome was the result 3/6/12 months after first presentation or surgery. The outcome was measured by using different categories – excellent, good, acceptable, poor, failure – based on objective measurements of diplopia, enophthalmos, and complications/sequelae, as explained in Table 1. Secondary outcome measures were complications or sequelae, such as diplopia, limited ductions, and enophthalmos. The subjective outcome was recorded by a diplopia QoL questionnaire.
Table 1 Classification of the outcomes of this study, based on the severity of diplopia, enophthalmos, and other complications or sequelae.
Excellent Good Acceptable Poor Failure
No diplopia, enophthalmos 0-2 mm, no other complications/sequelae No diplopia, enophthalmos 0-2 mm, other minor complications/sequelae Diplopia in areas score 1 (absence of head tilt), enophthalmos 0-2 mm Diplopia in areas score 1/2 (absence of head tilt), enophthalmos >2 mm
Revision surgery due to severe disability caused by unimproved diplopia or enophthalmos, major complications/sequelae
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