Surgical indications of orbital fractures depending on the size of the fault area determined by computed tomography: A systematic review

Abstract

Introduction: Surgical treatment of the orbital fractures is used in an attempt to prevent or treat complications, such as the enophthalmos, double vision, or limitations in ocular movements. The aim of this study is to carry out a systematic review of the literature in order to quantify the fault area in orbital walls. It also aims to increase the volume of the orbital cavity in the orbital traumatism that determines the appearance of ocular symptomatology and that, in turn, may require surgical reconstruction. Material and methods: An electronic search was conducted in Medline (Pub-Med) using the terms: "orbital", "volume", "fracture", "enophthalmos" and "computer". Only these studies that relied on CT measurements, only included fractures of floor and medial wall of the orbit, and fulfilled the criteria for high methodological quality, were selected. Results: Various studies determine that fractures with areas greater than 1.10•2.00 cm2, as well as an increase in orbital volume, will lead to the appearance of enophthalmos in 10•15% of the cases. In addition, for every 1 cm3 increase in the volume of the orbital cavity, the enophthalmos increases between 0.47 mm and 0.90 mm. Conclusions: According to the published results, surgical orbital reconstruction is indicated for faults greater than 2 cm2, with a volume greater than 1.62 cm3, an orbital volume greater than 10•15% of the orbital cavity, or when the fracture is located in the innermost region, between the floor and medial wall of the orbit in the so called "key area".