Page 119 - Advanced concepts in orbital wall fractures

to be more incapacitating. BSV scores improved gradually in both groups up to 12 months follow-up, with a significant improvement in the postoperative period 2 weeks to 3 months. This gradual improvement of diplopia confirmed the findings in similar studies20,52.
Limitations in horizontal ductions were less extensive than limitations in vertical ductions. An alleged reason for this was that most of the fractures involved the orbital floor. Limitations in vertical duction were greater in the surgical group at first presentation (-23.3 degrees, SD 13.8) compared with the nonsurgical group (-10.0 degrees, SD 11.6). Both groups showed improvement over time, however, the improvement was only statistically significant in the nonsurgical group. Bianchi et al. conclude that incomitance was associated with the severity of the fracture and long- term diplopia21. This could explain the patients with a poor outcome in the surgical group.
The QoL score is unique, with patient-related outcome measurements
rarely used in orbital trauma research. Quality of life was previously
described following orbital decompression surgery in Graves patients53.
An increase in score of 6-10 points after decompression or strabismus C surgery was seen as an improvement by the patient54. It is not possible 6 to compare scores before and after trauma, but changes over time could
clearly be identified in this study. Folkestad et al. stated in their report on zygomatico-orbital fractures that diplopia 12 months postoperatively was not experienced as a major problem as it was usually only present in extreme vertical gaze55. The diplopia QoL score may prove to become an important patient-related measure in evaluating trauma treatment strategies56.
No significant increase in enophthalmos was found in the nonsurgical group. The observed significant difference in the surgical group is believed to be caused by a decrease in enophthalmos following surgery. Late enophthalmos did not develop in both the nonsurgical and surgical groups. This may be noteworthy as there were several large defects in the nonsurgical group (Fig. 3). Young et al. state that, over time, a decrease in fracture size and a reduction in orbital herniation may be possible57.
Clinical perspective
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