计算机辅助导航系统和个体化三维钛网在陈旧性眶颧骨折治疗中的应用

目的:研究计算机辅助导航系统结合个体化三维钛网在复合性眼眶骨折治疗中的应用,并与传统手术方法进行比较,评价其治疗效果。方法:2008年10月-2010年12月在上海交通大学医学院附属第九人民医院口腔颌面外科和眼科联合治疗的陈旧性单侧眶颧骨折伴眼球内陷畸形病例64例,其中25例采用计算机辅助手术治疗以提高颧骨复位的准确性,术前眼球内陷平均5.71mm;39例采用传统方法治疗,术前眼球内陷平均4.96mm。眶重建中,35例采用钛网,12例采用聚乙烯聚合物(Medpor),5例采用羟基磷灰石板(HA),12例采用钛网+Medpor或HA。手术前后进行眼眶CT扫描、冠状和三维骨重建,术后评价颧骨复位和眼球内陷矫正效果。结果:计算机辅助治疗术后颧骨复位的满意率为92%,眼球突度满意率(≤2mm)为82%,轻度眼球内陷率(≤3mm)为17%。传统手术颧骨复位满意率为74%,眼球突度满意率为74%,轻度眼球内陷率(≤3mm)为19%,中度眼球内陷率(≤4mm)为6%。眼球突度满意率,单纯使用钛网为74%,联合材料为83%,Medpor为67%,HA为20%。结论:计算机辅助手术可提高陈旧性眶颧骨折伴眼球内陷畸形的治疗效果;钛网联合Medpor是治疗严重眼球内陷畸形的良好方法。     

114 例眼眶骨折分析

目的:探讨眼眶骨折的诊断和治疗原则。方法:回顾分析了114例眼眶骨折的患者,分类统计其临床表现和治疗方法。结果:眼球运动障碍、复视和眼球内陷发生率分别为63.2%、62.3%和59.6%;视神经损伤、泪道损伤和眼球破裂的发生率分别为15.8%、15.8%和12.3%。95.6%的患者接受了眶壁整复和人造骨植入术;72.8%的患者进行了骨折复位内固定术;部分患者进行了视神经减压术、眼球修补术和泪道手术。结论:眼球运动障碍、复视和眼球内陷是眼眶骨折的主要临床表现,视神经损伤、眼球破裂和泪道损伤亦不能忽视;眶壁整复和人造骨植入术是眼眶骨折治疗的主要术式,非单纯性眼眶骨折还需行骨折复位内固定术。     

Medial orbital wall fracture with enophthalmos

An isolated blow-out fracture of the medial orbital wall is uncommon, whereas the incidence in conjunction with an orbital floor fracture is high. The most striking features of an isolated medial wall fracture are diplopia on medial and lateral gaze and/or enophthalmos. The cases of two patients with a fracture of the medial orbital wall with enophthalmos are presented. One patient had an isolated medial wall fracture, whereas the other had a combined medial and inferior orbital wall fracture. Treatment of the enophthalmos consisted of exposure of the medial wall fracture site using a bicoronal flap, freeing of the herniated soft tissues and reconstruction of the defect with an autogenous medial iliac bone graft. The incidence, aetiology, pathogenesis, signs and symptoms and surgical treatment of the isolated orbital medial blow-out fracture are discussed.     

Minimization of zygomatic complex fracture treatment.

The aims of this non-randomized prospective study were to establish and justify minimized therapy for zygomatic complex fractures. Fifty-two consecutive patients were examined and classified with conventional routine radiographs. Preoperative symptoms were recorded. Treatment of zygomatic fractures was by percutaneous hook reduction and miniplate fixation along the frontozygomatic suture. Exploration of the orbital floor was carried out only in cases of primary diplopia or comminuted fractures. Postoperatively, patients were followed for 12 months. Clinical and radiologic assessment of reduction was symmetric and stable in all cases. Preoperative symptoms disappeared completely except for sensitivity disturbance in five patients. Patients with no post-trauma diplopia did not develop eye motility disturbances or enophthalmos. The treatment of a zygomatic fracture is possible by the described technique. Exploration of the orbital floor is indicated only in cases of preoperative diplopia. Therefore, a patient with a zygomatic fracture and diplopia should be classified as having a orbitozygomatic fracture. In cases of comminuted fractures, exploration of the orbital floor remains mandatory.     

微创下实施内固定治疗颧骨骨折的疗效及安全性

目的 探讨经口内微创入路实施内固定治疗颧骨骨折的临床疗效及安全性。方法 选取2005年6月—2013年6月收治的71例颧骨骨折患者,随机分为实验组和对照组。实验组采用经口内径路切开复位及微型钛板内固定术,对照组采用经冠状切口切开、明视下骨折复位及微型钛板内固定术。比较2组患者术前及术后3个月的伤侧鼻侧、颞侧运动度、开口度和眼球内陷程度,比较2组患者术后6个月的临床疗效及术后并发症发生率。采用SPSS18.0软件包对数据进行统计学分析。结果 2组患者术后3个月的伤侧鼻侧、颞侧运动度均显著低于术前（P<0.01）;实验组术后3个月的伤侧鼻侧、颞侧运动度均显著低于对照组（P<0.01）。2组患者术后3个月的开口度显著大于术前,眼球内陷程度显著小于术前（P均<0.01）;实验组术后3个月的开口度显著大于对照组,眼球内陷程度显著小于对照组（P均<0.01）。实验组术后半年的临床疗效显著高于对照组（P<0.05）。实验组的术后并发症发生率显著低于对照组（P<0.05）。结论 经口内微创实施内固定治疗颧骨骨折创伤较小,同时手术疗效佳,术后并发症发生率低,值得临床推广应用。     

Clinical signs of orbital wall fractures as a function of anatomic location

OBJECTIVE: The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. STUDY DESIGN: The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. RESULTS: Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall. CONCLUSION: Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.     

Orbital floor reconstruction with an alloplastic resorbable polydioxanone sheet

The orbital floor is frequently reconstructed after blow-out fractures or midface fractures to avoid a relapse of the repositioned orbital tissue and to prevent enophthalmos. A total of 31 patients underwent reconstruction of internal orbital wall fractures with a resorbable 0.25 mm or 0.5 mm-thick polydioxanone implant (PDS). Skeletal and functional outcome was evaluated retrospectively with regard to fracture size. Fracture size was graded as small, moderate or large by CT scans and operating records. Two of the 25 patients with small or moderate defects showed an enophthalmos of 2-3 mm. Five of the six patients with large defects or two orbital wall fractures had enophthalmos. The scar that formed after implant resorption was to weak to provide adequate support of the globe or to compensate the enlarged orbital volume. Endoscopic follow-up examination of 12 patients showed yielding of the scar in the orbital floor already in moderate defects. Eight patients had diplopia in extreme gaze and two had significant diplopia. Blow-out and midfacial fractures with small to moderate defects in the orbital floor (up to a size of 2.5 cm2) can be reconstructed by polydioxanone sheet to avoid enophthalmos. Polydioxanone implants should only be used in cases without massive orbital fat herniation. The scar formed after implant resorption may influence functional outcome.     

Transcaruncular approach for reconstruction of medial orbital wall fracture

Medial orbital wall fractures can cause horizontal diplopia and enophthalmos. Therefore, reconstruction of displaced medial wall fractures should be considered. We used a transcaruncular approach in five male patients to reconstruct the medial orbital wall after acute injuries and also as a secondary procedure for enophthalmos correction. Four of these patients had a concomitant orbital floor fracture. The incision was made in the caruncule and extended in the conjunctiva superior and inferior into the fornices for 10-12 mm. The tissue was bluntly dissected in an anteroposterior direction. The periosteum was incised dorsal of the posterior lacrimal crest and after elevation of the periosteum, the fractured orbital wall was visible. Transplants up to a height of 2 cm could be inserted for reconstruction of the medial orbital wall. In the cases of acute trauma, the medial wall was reconstructed using a resorbable polydioxanone plate. Cortical bone was used for the reconstruction of late enophthalmos. No postoperative complications were found. The transcaruncular approach gave a rapid entry to the fractured medial orbital wall without a visible scar.     

非单纯性眼眶骨折眶腔容积改变与眼球内陷相关性研究方法初探基于CT图像数据的计算机辅助测量

目的应用计算机辅助三维CT影像分析系统，测量分析非单纯性眼眶骨折术前术后眶腔容积变化，为定量诊断和矫治骨折继发眼球内陷探索可行性研究方法。方法2004年10月～12月北京大学口腔医院颌面创伤中心经治的7例颅颌面创伤合并单侧非单纯性眼眶骨折。投照薄断层（0．625mm）CT，将图像数据以DICOM格式输入图像分析软件，对眼眶及眶内容物进行三维重建。描述眶腔破坏特征。测量眼球突度、原骨折和虚拟恢复眶外缘后的眶腔容积，并做术前术后比较分析。结果应用该系统可形象直观地显示眼眶畸形部位、范围。定量明确眼眶体积扩大量。在该类眼眶骨折中，骨折可波及整个眶壁。与眶缘骨折相比较，眶壁骨折与眼球内陷关系密切。术前术后比较，眼球内陷得到不同程度的改善，健患侧眼眶体积之差进一步缩小。结论基于CT图像数据的计算机图像分析系统可以清晰直观的显示出骨折眶壁畸形，以及健患侧眶腔体积的差异。球前和球后眶腔容积差可以为进一步探求眼眶破坏与眼球内陷的相关关系及量化诊断提供重要参数。     

Medial orbital wall fractures and the transcaruncular approach

We review the literature on medial orbital wall fractures and perform a meta-analysis on outcomes with the transcaruncular approach. The reported incidence for this injury ranges widely, although diagnosis can be made effectively with clinical examination and computed tomography. Clinical sequelae can include rectus entrapment or herniation, enophthalmos, and diplopia. Local injuries occurring in high concordance include concomitant fractures of the orbital floor and nasal fractures, although anterior cranial fossa extension, ocular trauma, other craniofacial injuries, and polytrauma must be ruled out. Indications for operative intervention include large defects, early or persistent enophthalmos particularly if causing diplopia, and rectus muscle entrapment.Various surgical approaches to the medial orbit have been described; however, the transcaruncular approach offers direct, reliable access without creating a cutaneous scar on the central face. A meta-analysis was performed on all studies reporting outcomes of the transcaruncular approach. A total of 228 cases were pooled, finding a favorable overall complication rate of 2.6%. Half of these complications required surgical correction and half resolved nonoperatively.Medial orbital wall fractures are an increasingly appreciated injury requiring clinical and radiologic assessments. When indicated, reconstruction of the medial orbital wall can be safely and effectively performed with the transcaruncular approach. Additional prospective outcomes studies are required to elucidate (1) the incidence of medial orbital wall fractures, (2) indications for operative versus nonoperative management, and (3) outcomes analysis of the transcaruncular approach compared with other approaches.     

The transcaruncular approach to orbital fracture repair: ophthalmic sequelae

The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.     

Evaluation of computer-based area and volume measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor.

PURPOSE: In this retrospective study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from coronal computed tomography (CT) scans and their relationship to ophthalmologic findings. PATIENTS AND METHODS: Fracture area and volume of displaced tissue of blowout fractures in 38 patients were measured from coronal CT scans. Measurement was performed by identifying distances (for area calculation) of the fracture and identifying areas (for volume calculation) of the displaced tissue in each CT slice. The calculated data were then compared with the amount of enophthalmos, presence of diplopia, and limitation of ocular motility. RESULTS: Orbital floor area (mean +/- SD) was 5.72 +/- 1.07 cm(2); fracture area, 2.63 +/- 1.20 cm(2); and the volume of displaced tissue, 1.15 +/- 0.91 mL. The average proportion of the fracture within the orbital floor was 45.3 +/- 17.6%. Fracture area and volume of displaced tissue were significantly positively correlated with enophthalmos and diplopia and not correlated with the limitation of ocular motility. For enophthalmos of 2 mm or greater, mean fracture area (mean +/- SD) was 4.08 +/- 1.09 cm(2) and volume of displaced tissue was 1.89 +/- 1.19 mL; for less than 2-mm enophthalmos, 1.98 +/- 0.83 cm(2) and 0.83 +/- 0.58 mL, respectively. Enophthalmos of 2 mm can be expected with 3.38 cm(2) of fracture area and 1.62 mL of displaced tissue. CONCLUSIONS: Region-of-interest measurement from coronal CT scan has an application in the assessment of patients with pure blowout fractures of the orbital floor and adds useful information in posttraumatic evaluation of orbital fractures.     

A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate.

PURPOSE: The purpose of this study was to compare our clinical findings on the use of autogenous bone grafts and bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] implants to repair inferior orbital wall defects. PATIENTS AND METHODS: Thirty-nine patients who suffered orbital blow-out fractures with >or=2 cm2 bony defect in the inferior orbital wall took part in the study. Each inferior orbital wall was reconstructed using either an autogenous bone graft or a triangle form plate of P(L/DL)LA 70/30. Computed tomography scans were taken before the operation and at 2 and 36 weeks postoperatively. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, numbness, gaze restrictions, size of bony defect after treatment, bone growth, and implant resorption. A comparative study was carried out using chi2 test and the Fisher exact test. We considered P < .05 to be statistically significant. RESULTS: The clinical outcome was excellent in 19 of the 24 (79%) cases treated with autogenous bone grafts and in 13 of the 15 (87%) cases treated with P(L/DL)LA 70/30. No statistically significant differences were found between the 2 groups in overall type or number of complications. The most frequent type of complication found in both groups was enophthalmos, with 5 cases (bone graft, 3; P(L/DL)LA plates, 2). Diplopia was the second most frequent type of complication; however, both complications caused no need for the removal of the implants in either group. CONCLUSION: Autogenous bone grafts and P(L/DL)LA 70/30 implant plates do not present statistically significant differences in the parameters studied. Taking into account the availability and the advantages of P(L/DL)LA 70/30 implants when compared with autogenous bone grafts, our results allow us to conclude that there is no compromise regarding successful bridging of orbital floor defects using biodegradable P(L/DL)LA 70/30 osteosyntheses.     

Straightforward factors for predicting the prognosis of blow-out fractures

In blow-out fractures, some nonoperative cases have a poor outcome, and a method for accurate prognosis is required. To address this need, we retrospectively reviewed blow-out fractures presenting at Teikyo University Hospital between July 2004 and May 2007 and conducted a survey regarding diplopia and enophthalmos for nonoperative cases. Computed tomographic scan findings were divided according to fracture width and the degree of protrusion of the inferior rectus muscle into the maxillary sinus. We had 106 patients presenting with blow-out fractures, and 89 patients had been treated nonoperatively. In medial orbital wall fractures, no patient had diplopia, and 1 patient had enophthalmos after nonoperative treatment. In punched-out orbital floor fractures, all cases had diplopia when the fracture width was less than half the diameter of the globe, and the protrusion of the inferior rectus muscle into the maxillary sinus was half or more of its section. Even if the fracture width was less than half the diameter of the globe, 2 of 3 patients had enophthalmos when the protrusion of the inferior rectus muscle into the maxillary sinus was half or more of its section. Among the linear orbital floor fractures, 1 case required an emergency operation. We suggest a new algorithm for treatment of blow-out fractures based on computed tomographic scan findings that can also contribute to making a prognosis.     

Endoscopic Assisted Combined Transantral and Subciliary Approach in Treatment of Orbital Floor Fracture: A Case Report

Management of orbital floor fracture remains the most debated topic in maxillofacial field. There are many approaches to reconstruct orbital floor fractures and restore orbital position and function, but many have the drawback of incomplete visualization, especially of the posterior part of the orbit. Pain, diplopia and enophthalmos are the most common presenting symptoms in patients who sustained orbital blow out fracture. The main aim in treating orbital fracture is to reduce the prolapsed orbital tissue and reconstruct the floor which will improve diplopia and enophthalmos. As minimally invasive surgical techniques are gaining popularity, it is possible to reconstruct the orbital fracture defects using endoscopes. Endoscopic assisted combined transantral and subciliary technique provides better surgical access and outcome in the treatment of orbital floor fracture.     

A 10-year analysis of the “Amsterdam” protocol in the treatment of zygomatic complex fractures

Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4–87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.     

Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study

OBJECTIVE: The purpose of the study was to investigate whether a flexible, biodegradable material (Ethisorb) shows better long-term results with regard to diplopia, bulbus motility, and exophthalmos/enophthalmos compared to the use of lyophilized dura-patches and polydioxanone (PDS) foils. METHODS: During a period of 6 years 435 patients with an orbital fracture were investigated retrospectively. Inclusion criteria were patients with fractures of the orbital floor with a maximum size of 2 x 2 cm. Bulbus motility, exophthalmos, enophthalmos, and diplopia were investigated during a period of 2 years. RESULTS: One hundred twenty orbital floors were reconstructed by lyophilized dura-patches, 81 by PDS, and 136 by Ethisorb. An exploration without an implantation was performed in 91 patients. The long-term investigation 12 to 15 months after surgery showed an exophthalmos and enophthalmos incidence of 1%, whereas a reduced bulbus motility and diplopia were found in 5% and 4%, respectively. Fifteen to 24 months after surgery 2% of the patients had an exophthalmos and 1% had an enophthalmos. A reduction of bulbus motility was found in 4% of the patients, and diplopia was found in 3%. The use of Ethisorb resulted in a significantly lower incidence of exophthalmos 3 months after surgery compared to PDS. CONCLUSION: The low rate of acquired bulbus motility demonstrates acceptable results in using Ethisorb in the floor of the orbit.     

Exploration of the orbital floor: an indicated procedure?

Fractures to the middle third of the facial skeleton continue to increase in frequency secondary to motor vehicle accidents and interpersonal violence. Orbital floor fractures can occur either independently or may be associated with other facial bone fractures. Controversy has persistently surrounded the treatment of fractures to the floor of the orbit. We will present our investigation of 296 patients who sustained a total of 396 traumatic injuries to the orbit and were treated at the University of California, Davis Medical Center, Sacramento, California, during the period July 1, 1988 to June 30, 1989 to determine whether surgical exploration of the orbital floor is necessary or adds potential serious risks. In the 38 patients (46 orbits) who did not undergo surgical exploration of the orbital floor, 31 (82%) suffered serious residual complications. In the remaining group of 258 patients who underwent orbital floor exploration, there was a 7 percent incidence (18 patients) with residual sequelae. We conclude that exploration of the orbital floor has the potential to decrease the incidence of serious post-traumatic complications significantly, primarily enophthalmos.     

Diplopia and enophthalmos in blowout fractures

The aim of this study was to compare the changes of diplopia and enophthalmos in patients with blowout fractures. Three hundred sixty-two patients who presented with blowout fractures between March 2006 and February 2011 were analyzed. The sequential time changes of diplopia and enophthalmos were measured in the operated group and the observed group according to (1) the duration of preoperative observation (early: within 7 days, late: 8-14 days, delayed: >15 days); (2) the defect size (minimal: <1 cm(2), small: 1.1-2.0 cm, medium: 2.1-3.0 cm(2), large: >3.0 cm(2)); and (3) the age of the patients (<20, 21-40, 41-60, >61 years).Among the 362 patients, 242 (66.9%) had an operation, and 120 (33.1%) did not. The duration of preoperative observation did not affect the postoperative diplopia or enophthalmos. There were significant differences of enophthalmos among the operated groups with a different defect size at the preoperative period (P = 0.036 [Pearson χ(2)]). There were significant differences of diplopia among the operated groups with different defect sizes at the 6 months' follow-up period (P = 0.014 [Pearson χ(2)]). The diplopia in the older age group (>60 years) was significantly greater than that of the other 3 groups at 6 months (P = 0.023) and at 12 months (P = 0.023, [Pearson χ(2)]).We think surgery should be delayed until the swelling is decreased unless the medial rectus muscle is incarcerated. We also think that the defect size is not an important factor for whether to perform surgery. We think that the reason for the greater diplopia in the older age group is that the adaptation of binocular convergence is decreased in the older age group.     

Functional outcome after non-surgical management of orbital fractures—the bias of decision-making according to size of defect: critical review of 48 patients

The treatment of mild and moderate fractures of the orbital wall is controversial. Apart from clinical signs, the size of the defect is often used to aid the decision about treatment. We hypothesised that variables would be present that had an impact on the position and motility of the globe but were independent of the size of the defect, and prevented a balanced judgement of the outcome of conservative treatment. Between January 2000 and December 2007, 48 of 127 patients were included in this retrospective study to analyse the functional outcome of orbital fractures managed without operation. Selection was dependent on the availability of complete clinical records, post-traumatic computed tomographic (CT) scans (axial and coronal sections) and ophthalmic examination. All 48 defects were analysed and allocated to categories of a semiquantitative classification. The area of fracture of each defect was calculated with an integral calculus or geometrical formula and correlated with the associated category. Category A included all orbital walls as a single unit (A1) and combined fracture patterns (A2 and higher). Category B described isolated fractures of the medial wall. There was a significant correlation between classes A1 and A2 (p < 0.01) and absolute area of the fracture (0.98 (0.4) cm² and 2.42 (0.8) cm²). Diplopia was most often seen in fractures in category B1 (the anterior third of the medial wall) and the post-traumatic position of the globe significantly correlated with the area of the fracture (p = 0.04). The degree of diplopia was less severe in fractures of the posterior portion of the orbit (zones 2 and 3) compared with fractures of the anterior orbit, even if the defect was larger. The conservative management of category A1-3 and B1-3 fractures up to 2.42 (3.15) cm² showed no functional impairment, provided that enophthalmos was less than 2 mm and there was no entrapment of periorbital tissue or extraocular muscles. We found good correlation between enopthalmos and the size of the fracture, but not for diplopia or motility of the eye. We conclude that conservative management of an orbital fracture in which the defect is less than 3 cm² has a low risk of permanent functional damage if enophthalmos is less than 2 mm and entrapment of soft tissue or muscles is excluded.