Isolated fractures of the orbital floor. Conclusions of a retrospective study of 85 cases]

We present a retrospective study of 85 patients presenting an isolated orbital floor fracture between 1993 and 1997; 79 of them (93%) were operated via a subciliary or transconjunctival approach. Surgical procedure included autologous graft or biomaterial (coral, polydioxanone) depending on the cases. The study was focused on clinical data (concerning diplopia, enophthalmia and sensorial disturbances) which were recorded pre- and post-operatively. RESULTS: 58 patients (68%) had a pre-operative diplopia, and 9 (11%) had a persistent post-operative diplopia: all of these patients were operated more than 8 days after trauma; no post-operative diplopia occurred without pre-operative diplopia; 8 patients (9%) presented a pre-op enophthalmia: all of them came more than 10 days after the trauma; a perfect symmetry was obtained post-operatively in only one of these 8 patients; no enophthalmia occurred in patients without pre-op enophthalmia; sensorial disturbances were seen pre-operatively in 27 patients (32%) and post-operatively in 17 (20%); no correlation was found with the timing or the procedure of the surgery. COMMENTS: The interest of an early diagnosis and treatment is confirmed, in order to avoid late functional (diplopia) or esthetic (enophthalmos) disturbances. Thus it seems necessary to obtain a computed tomography for any orbital trauma as conventional radiography can be less sensitive. Concerning the surgical procedure, resorbable biomaterials seem to be very well tolerated and easy to use. Autologous bone grafts always lead to a certain degree of morbidity without real advantage. The best way seems to be the trans-conjonctival approach, but subciliary incisions can also be used in these cases. The most important remaining problem to solve is probably focused on sensorial disturbances: their incidence is high and there is a high rate of sequels: further studies are obviously necessary to improve the knowledge of etiopathogenic factors and determine the best therapeutic attitude.