![]() Cutting through the periorbita and exposing the orbital floor defect, herniated tissues are released. ![]() We operate through a combination of subciliary and subtarsal approaches in the region of the lower eyelid, accessing the periorbita through the orbitalis oculi muscle. Where the decision to perform surgery was made, the intervention was performed once the swelling had subsided. All the above examinations were repeated during follow-ups. The decision whether or not to operate was made strictly individually in each patient, considering multiple factors, among others the defect size and position, enophthalmos on the affected side >2 mm, or ocular motility disorder (with or without binocular diplopia). Based on all those findings, a team consisting of a maxillofacial surgeon and ophthalmologist decided about the treatment methods (conservative/surgical revision with orbital floor reconstruction). The ocular motility disorders were objectively assessed and documented by the Lancaster screen test. The eye position in the anterior-posterior orbital axis was assessed using Hertel exophthalmometer. The examination included the evaluation of refraction, near and far vision, intraocular pressure, biomicroscopic examination of the anterior and posterior segments of both eyes, examination of motility, fixation, accommodation and convergence, of binocular spatial functions using colour filters, Worth four lights and Bagolini striated glasses tests, the degree of strabismus in prism cover test and by synoptophore. The complex examination by an ophthalmologist took place several days after the injury, which allowed time for the initial swelling to partially subside and, therefore, to help us distinguish between ocular motility disorders caused by intraorbital swelling/bleeding from true ocular motility disorders. The acquired data were subsequently used for calculating a percentage of the defect in the direction of each axis and of the orbital floor area.Īll patients were examined by a maxillofacial surgeon and by an ophthalmologist. The convex shape of the orbital floor was not considered due to the software capabilities. The size of the orbital floor defect was measured using defect-delineating and orbital floor delineating tangents in the xVisionViewer software (Vidis, s.r.o, Prague, Czech Republic) and evaluated both in the mediolateral and anterioposterior axes on frontal and sagittal slices of the orbit. In each patient, a CT scan with slices below 1 mm was performed, meeting the guidelines and criteria set by the American College of Radiology. Providing that the success rate was good, additional aims were to identify possible factors, the presence of which can be associated with the chosen treatment path and based on a detailed analysis of those factors, to propose an easy-to-use pilot scoring system for individualized referring to surgical or conservative treatment. The aims of the presented study were to retrospectively evaluate the results of the conservative and surgical treatment of isolated blowout fractures at our department based on given criteria of therapy success. As orthoptic examination is the best-suited method for diagnosing ocular motility disorders, the fact that its use in the decision making related to OFBF treatment is largely neglected is actually quite surprising –. The diagnosis and treatment of ocular motility disorders are a complex process. patients with preexisting concomitant strabismus with an alternating suppression) –. Here, it is, however, necessary to mention that binocular diplopia may not be obvious and in some cases, it can be altogether missing despite the presence of a clear ocular motility disorder ( e.g. The most common criteria include the size of the defect exceeding one-third of the orbital floor or binocular diplopia resulting from the disruption of ocular motility due to the herniation of soft tissues into the defect. At present, no guidelines facilitating the decision making which of those treatment options to choose and the decisions depend to a great degree on the general experience and habitual practices of the individual departments. ![]() ![]() In patients with orbital floor blowout fractures (OFBF), two principal treatment options are available: conservative and surgical treatment. ![]()
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