Background. Orbit is involved in 40% of all facial fractures. There is considerable variety in severity, ranging from simple nondisplaced to complex comminuted fractures. Complex comminuted fractures (up to 20%) are responsible for the majority of complications and unfavorable results. Orbital fractures are classified as internal orbital fractures, zygomatico-orbital fractures, naso-orbito-ethmoidal fractures and combined fractures. The ophtalmic sequelae of midfacial fractures are usually edema and ecchymosis of the soft tissues, subconjuctival hemorrhage, diplopia, iritis, retinal edema, ptosis, enophthalmos, ocular muscle paresis, mechanical restriction of ocular movement and nasolacrimal disturbances. More severe injuries such as optic nerve trauma and retinal detachments have also been reported. Within the wide range of orbital fractures small group of complex fractures causes most of the sequelae. Therefore identification of severe injuries and adequate treatment is of major importance. The introduction of craniofacial techniques made possible a wide exposure even of large orbital wall defects and their reconstruction by bone grafts. In spite of significant progress, repair of complex orbital wall defects remains a problem even for the experienced surgeons.
Results. In 1999 121 facial injuries were treated at our department (Clinical Centre Ljubljana Dept. Of Maxillofacial and Oral Surgery). Orbit was involved in 65% of cases. Isolated inner orbital fractures presented 4% of all fractures. 17 (14%) complex cases were treated, 5 of them being NOE, 5 orbital (frame and inner walls), 3 zygomatico-orbital, 2 FNO and 2 maxillo-orbital fractures.
Conclusions. Final result of the surgical treatment depends on severity of maxillofacial trauma. Complex comminuted fractures are responsable for most of the unfavorable results and ocular function is often permanently damaged (up to 75%) in these fractures.
Jurca M. Prikaz maksilofacialne travme v SR Sloveniji. Zobozdrav Vestn 1979; 1-2: 25–8.
Ellis E, Attar A, Moos KF. An analysis of 2067 cases of zygomatico-orbital fractures. J Oral Maxillofac Surg 1985; 417–28.
Eberlinc A. Obrazne poškodbe. II. Zbornik predavanj 36. podiplomskega tečaja kirurgije. Ljubljana, 2000: 55–62.
Kansky AA. Poškodbe maksilofacialne regije. Med Razgl 2000; 39: S 11: 95– 100.
Zide BM, Jelks GW. Surgical anatomy of the orbit. New York: Raven Press, 1985.
Hammer B. Orbital fractures – diagnosis, operative treatment, secondary corrections. Seattle: Hogrefe & Huber Publishers, 1995.
Manson PN, Ruas EJ, Iliff NT. Deep orbital reconstruction for correction of posttraumatic enophtalmos. Clin Plast Surg 1987; 14: 113–21.
Ochs MW, Buckley MJ. Anatomy of the orbit. Oral Max Fac Surg Clin North Am 1993; 5: 419–29.
Yab K, Tajima S, Imai K. Clinical application of a solid three-dimensional model for orbit wall fractures. J Cranio-Max Fac Surg 1993; 21: 275–8.
Pearl RM. Treatment of enophtalmos. Clin Plast Surg 1992; 19: 99–111.
Nguyen PN, Sullivan P. Advances in the management of orbital fractures. Clin Plast Surg 1992; 19: 87–98.
Converse JM, Smith B, Obear MB, Wood-Smith D. Orbital blow out fractures: a ten year survey. Plast Reconstr Surg 1867: 39: 20–33.
Leipziger LS, Manson PN. Nasoethmoid orbital fractures. Current concepts and management principles. Clin Plast Surg 1992; 19: 167–93.
Acartürk S, Dalay C, Kivanc Ö, Varinli I. Orbital apex syndrome associated with fractures of the zygoma and orbital floor. Eur J Plast Surg 1993; 16: 67–9.
Fukado Y. Results in 400 cases of the surgical decompression of the optic nerve. In: Streiff EB ed. Modern problems in ophtalmology, vol. 14. Basel: S. Karger, 1975: 474–81.
Funk GF, Stanley RBJ, Becker TS. Reversible visual loss due to impacted lateral orbital wall fractures. Head Neck Surg 1989; 11: 295–300.
Leban V. Rentgenska diagnostika v maksilofacialni regiji. Zobozdrav Vestn 1986; 1-2: 22–31.
Frodel JLJ, Marenette LJ, Quatela VC, Weinstei GS. Calvarial bone graft harvest. Techniques, considerations and morbidity. Arch Otolaringol Head Neck Surg 1993; 119: 17–23.
Ilankovan V, Jackson IT. Experience in using calvarial bone grafts in orbital reconstruction. Br J Oral Maxillofac Surg 1992; 30: 92–6.
Freihofer HP, Van Damme PA. Secondary posttraumatic periorbital surgery. J Cranio-Max Fac Surg 1987; 15: 183–7.
Tessier P, Gerard G, Derome P. Orbital hypertelorism. Scand J Plast Reconstr Surg 1973; 7: 39–58.
Gorjanc M, Kansky AA. Postopki in zapleti zdravljenja zlomov spodnje čeljustnice. Med Razgl 2000; 39 (3): 141–5.
Hammer B, Kunz C, Schramm A et al. Repair of complex orbital fractures: technical problems, state-of-the-art solutions and future perspectives. Ann Acad Med Singapore 1999; 28: 687–91.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.