The Clinical Characteristics Of Extraocular Muscle Function Changes Before And After Reconstruction In Orbital Blowout Fracture Patients

Diplopia and enophthalmos were the major characteristic manifests fororbital fracture patients. Enophthalmos could affect patients' facialappearance, and diplopia would affect patients' daily life. So the main purposeof orbital blowout fracture reconstruction is to eliminate diplopia and resolveenophthalmos. To date, there were few detailed, systemic clinical data toevaluated extraocular muscle function changes of orbital blowout fracturepatients from the view of ophthalmologists.During the 3 years from March of 2002 to June of 2005, 130 blow outorbital blowout fracture patients (105 men and 25 women) were diagnosed andoperated with full follow-up datqa. Mean age was 31.07 years (ranging from 6to 58 years old). The mean delay time between the day of injury and surgerieswas 18 days (range, 1day to 180 days)。Complete ocular examinations wereprocessed。There were 43 patients (33.08%) who were diagnosis as isolatedmedial orbital fracture, 36 (27.69%) inferior orbital fracture and 51(39.23%)complexed medial and inferior orbital fractures. All the patients were evaluatedby axial and coronal computed tomography scans,and three-dimension CTconstruction necessarily to confirm the clinical diagnosis. All patients wereinvestigated by candle double vision test and synoptophore to check extraouclarmuscle functions.All data were analyzed statistically by SPSS bag 12.0.The consequence of candle double vision test and synoptophore after 6months of operation provided that diplopia of 28/34 patients with medialrectus restrictions were cured but 6 patients(6/34) were not improved obviously.Among the 18 cases with medial paralysis before operation , diplopiadiminished in 7 cases and 11 cases(11/18) were not relieved. The recovery rateof medial rectus restriction patients was better than that of medial rectusparalysis. There were obvious difference between the two group((χ2=10.1041P=0.0015)。Among the 34 cases with restriction of medial rectus, 20 cases (20/21)operated within 3 weeks after injuries were cured completely and 8 in delayedgroup. The recovery rate of the former group is better than the latter obviously( Fisher's exact probability P=0.02). Within the 18 cases with paralysis ofmedial rectus , 4/10 were relieved in the "early group" and 3/8 cases relieved inthe delayed group. There were no obvious difference between the two groups(Fisher's exact probability P=0.02).The consequence of candle double vision test and synoptophore withorbital floor blowout fracture after 6 months of operation provided that diplopiain 19 of 23 patients with inferior rectus restriction were diminished well. 6/34patients were not improved obviously. The diplopia in 7 of 19 cases withinferior rectus paralysis were relieved and rest of 11 cases(11/18) were notcured obviously.7/19 cases with inferior rectus palsy were recovered and 12 cases(12/19)were not. So, in general, the recovery rate of diplopia in patients with inferiorrectus restriction was better than that of with inferior rectus paralysis. Therewere obvious difference between the two groups(χ2=9.24 ,P=0.002)。13/23patients with restriction of inferior rectus operated within 3 weeks afterinjurehave good clinical results and 6 of 9 cases were not recovered asexpected in the delayed group. The recovery rate of the former is better thanthe latter obviously( Fisher's exact probability P=0.26).Among the 19 cases with paralysis of inferior rectus before operation,4 of11 patients were cured in "early group" and 3 in 8) were relieved in delayedsurgery group. There were no obvious difference between the two group(Fisher's exact probability P=1.00).Diplopia in 16/19 patients with complexed medial-inferior orbital fracturewere cured. 6 patients (6/34) were not improved obviously. Among the 20 caseswith medial paralysis before operation ,5 cases were recovered well. 17/21patients with inferior rectus restriction patients had complete recovery results.3 of 11 patients (3/11) with inferior rectus paralysis recovered from diplopiaand 5 patients were healed well among 15 patients with inferior oblique muscleparalysis before operation.The recovery rate of rectus restriction in the complexed medial-inferiororbital fracture group was better than that of rectus paralysis. There wereobvious difference between the two group(χ2=27.63 P<0.001)。In the early surgical group, 14/ 17 cases with rectus restriction hadsuccessful results and 18 in 23 for the delayed group. The recovery rate of the"early group" is better than the latter obviously( Fisher's exact probabilityP=0.26). In 26 cases with medial rectus and inferior oblique muscle paralysis, 9cases(9/26) were relieved in "early group" and 7 cases (7/23) for the delayedgroup..The recovery rate between two group is obvious difference( Fisher'sexact probability P=0.26).There are clinical characteristics of extraocular muscle functionchanges before and after reconstruction in orbital blowout fracture patients.Candle double vision test and synoptophore could evalvate extraocular musclesin different type orbital blowout fracture .The recovery rate of extraocular muscles restriction in each type of orbitalblowout fracture is better than that of the extraocular muscle paralysis group.The recovery rate for the patients with extraocular muscles restriction is muchhigher in "early surgery group" than that of delayed group. The recovery ratefor patients with extraocular muscles paralysis has not obvious differentcebetween the "early" and "delayed" groups.So the recovery rate of extraocular muscle functions are related tooperation time after injuries and the characteristic of extraocular musclefunction affacted.