Prediction of Enophthalmos in Medial Orbital Wall Fracture: Suggested Coordinate Plane for Making Surgical Decisions

Abstract

Background: Enophthalmos is one of the most distressing complications of blowout orbital fractures. Although several studies have been conducted on the topic of indications of early surgical correction, none have been performed using a set of measurable parameters. Methods: The study quantitatively examined orbital fracture areas (OFA) and volumes (OFV) retrospectively of 242 patients with isolated medial orbital wall fractures that were treated conservatively during a 12-year period (from 2009 to 2021). Three plastic surgeons measured enophthalmos >6 months after trauma. The correlations between parameters and enophthalmos in the study cohort were analyzed. In addition, patients treated operatively, and nonoperatively were compared with assess the suitability of the predictive model. Results: Significant correlations were observed between several parameters and late enophthalmos. Total 2.59 cm2 of OFA (ie, OFA >2.59 cm2) or 1.45 cm3 of OFV (ie, OFV >1.45 cm3) corresponds to 2 mm of enophthalmos. Multiple regression analysis revealed the following coefficients: −0.208 is a constant (P<0.001), with 0.695 and 0.372 for OFA and OFV, respectively (P<0.001 for both OFA and OFV). Conclusions: The study shows that enophthalmos can be more accurately predicted when OFA and OFV are simultaneously considered in patients with isolated medial wall fractures. Finally, an algorithm and a “blowout fracture coordinate plane” was proposed to aid treatment decision-making in isolated medial wall fractures.