Biomedical papers - Ahead of Print

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | 10.5507/bp.2017.036

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

Daniel Kovara,b, Zdenek Voldricha, Pavel Voskaa, Jan Lestakc, Jaromir Astla
a Department of ENT and Maxillofacial surgery, 3rd Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Czech Republic
b Faculty of Military Health Science in Hradec Kralove, University of Defence, Hradec Kralove, Czech Republic
c Eye Clinic FBMI CVUT Prague, Czech Republic

Background and Aim. The otolaryngologist often meets with fractures of the orbital floor. The most serious complication is diplopia, arising as a result of herniation of the orbital contents, with or without fixation of the inferior rectus muscle. The aim of our work was to create a mathematical model to calculate the volume of prolapsed soft tissue of the orbit in blow-out fractures, as a factor in deciding on the need for surgical treatment.

Patients and Methods: In a retrospective study (2007-2013), we evaluated 80 patients with blow-out fractures, divided into two equal groups: 40 conservatively treated and 40 surgically treated patients. We created the model by measuring the fracture lines and herniation of the orbital soft tissues in the coronal and sagittal sections from CT images, equivalent to half the volume of a rotating ellipsoid.

Results: According to the proposed model, posterior and anterior fractures with a prolapse volume above 500 mm3, and anteroposterior fractures with a volume over 1400 mm3, are indicated for surgery.

Conclusion: The volume of prolapsed soft tissue relative to the location of the fracture is the main indicator for selecting the best treatment procedure immediately after injury.

Keywords: blow-out fractures, volumometry, diplopia, CT-assisted surgery

Received: March 21, 2017; Accepted: August 22, 2017; Prepublished online: August 31, 2017


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