Retrospective Study Of Orbital Fractures And Orbital-Zygomatic Fractures And Evaluation Of Therapeutic Effects

Part 1Objective The aim of this study was to evaluate the clinical and epidemiological features of 264 patients with orbital wall fracture who were treated at Department of maxillofacial surgery,Stomatological Hospital of The Fourth Military Medical University,between 2012-2017.Methods The medical records of the patients with a diagnosis of orbital fracture were reviewed and analyzed.The patients were evaluated by age,gender,etiology,symptoms,examination findings,fracture location,associated injuries,treatment,and complications.Results The mean follow-up time was 6(3-10)months.The male-to-female ratio was 5.3:1.The average age was 32(6-82)years.The leading causes of orbital fractures were traffic accidents(36%)followed by assaults(32%).The most frequently affected orbital wall was the medial wall(33%).The main symptom was throbbing pain in the traumatized area(100%),and the main examination finding was periorbital edema and ecchymosis(100%).The most frequent associated injury was cerebral trauma(14%).134 patients(50.1%)were managed with medical treatment,and 130 patients(49.9%)underwent surgical treatment.The most common complication in the late period was dermatomal sensory loss(11%).Conclusion The leading causes of orbital fractures were traffic accidents followed by assaults.The most frequently affected orbital wall was the medial wall.This study shows that by preventing traffic accidents and strengthening anti-violence social education,the incidence of orbital fractures can be reduced.Part 2Objective The prevalence and etiology of orbital-zygomatic fractures varies among countries.Until now,knowledge about such type of injuries in China was rather scarce.The purpose of the study was to analyze the prevalence,etiology and localization of orbital-zygomatic fractures treated at Department of maxillofacial surgery,Stomatological Hospital of The Fourth Military Medical University.Methods The medical records of patients treated for orbital-zygomatic fractures during the period July 2008 to July 2017 were analyzed for gender,age distribution,frequency and type of injury,cause of fractures,consciousness status and alcohol abuse during trauma.Results The records of 799 patients were analyzed.The male-to-female ratio was 4.4:1.The mean age of the patients was 33.16 ± 14.0 years(min 1,max 87).The most frequent causes for injury were interpersonal violence(64%),followed by falls(16.3%)and traffic accidents(8.3%).Most orbital-zygomatic fractures(65.3%)occurred between April and October,on weekends(58.2%)and at night(62.0%).In 14%,trauma reports indicated the abuse of alcohol.More often such persons received more than one midfacial bone fracture.Conclusion This study revealed that the main cause of midfacial fractures was assault.Male patients,aged 15–34 years,more often sustain orbital-zygomatic fractures.Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family,school and community institutions.Part 3Objective Retrospective analysis of surgical or conservative treatment of orbital blowout fractures.Methods The study design is a retrospective cohort study and the setting is Department of maxillofacial surgery,Stomatological Hospital of The Fourth Military Medical University.The participants include patients with isolated BOFs admitted to our Department.The presence of diplopia and enophthalmus was determined by reviewing the medical records.Data from the patients’ initial consultation and their 3-month、6-month follow-up were also collected.Results Of the 90 consecutive patients included,65 had available follow-up data.Of the 65 patients whose data could be analysed,39 had been managed surgically and 26 conservatively.Of the patients managed surgically,19 had diplopia in peripheral gaze before surgery and 13 at 3-month and 12 at 6-month follow-up.31 had enophthalmus before surgery and 3 at 3-month and 6-month follow-up.Of the patients managed conservatively,11 had diplopia in peripheral gaze initially and 9 at 3-month and 8 at 6-month follow-up.15 had enophthalmus initially and 13 at 3-month and 6-month follow-up.Conclusion Primary gaze diplopia disappeared while secondary gaze diplopia was present in about a third of patients,whether managed surgically or conservatively at the 3-month and 6-month follow-up.Compared with conservative treatment,surgical treatment has better curative effect for the treatment of enophthalmus.No matter how the treatment was done,the patient tended to be stable 3 months after treatment.