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Jang, Leem, Baek, Shin, and Ko: Degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue
Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(3):205-213.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.3.205

Degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue

Hak-Sun Jang, Dae-Ho Leem, Jin-A Baek, Hyo-Keun Shin, Seung-O Ko

Department of Oral & Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Brain Korea 21 project, Chonbuk National University, Jeonju, Korea

Seung-O Ko Department of Oral & Maxillofacial Surgery, School of Dentistry, Chonbuk National University 664-14, Duckjindong, Jeonju, 561-756, Korea TEL: +82-63-250-2113 FAX: +82-63-250-2089 E-mail: omfskso@chonbuk.ac.kr

Received 10 February 2011       Revised 27 May 2011       Accepted 31 May 2011

Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

The enlargement and deformation of the orbit give rise to a visible enophthalmos. As a consequence, a disturbance of eye motility together with double images is likely to occur. This study examined the degree of enophthalmos according to the extent of orbital wall fracture and volume of herniated orbital tissue in blowout fractures of the medial and inferior orbital wall.

Materials and Methods

This study was performed on patients diagnosed with medial and inferior orbital wall fractures at the Department of Oral and maxillofacial surgery, Chonbuk National University Hospital from 2007 to 2009. The patients' age, gender, etiology of fracture and degree of enophthalmos were investigated. The changes in the degree of enophthalomos, diplopia and ocular motility restriction after operation were examined.

Results

The degree of enophthalomos increased with increasing extent of orbital wall fracture and volume of herniated orbital tissue.

Conclusion

Whether to perform the operation is decided after measuring the extent of the orbital wall fracture and volume of herniated orbital tissue using computed tomography (CT), time for the decision of operation can be shortened. This can cause a decrease in the complications of orbital wall fractures.

Keywords: Orbital wall fracture, Blowout fracture, Enophthalmos, Diplopia, Ocular motility restriction

References

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Fig. 1.
Enophthalmos measurement. A: Oculus exophthalmometry, B: Enophthalmos measurement method.
jkaoms-37-205f1.tif
Fig. 2.
The area of fracture site is calculated from measurements on coronal (A, C), axial (B), and sagittal (D) CT scan. a: Height of medial wall fracture, b: Length of medial wall fracture, c: Degree of medial displacement of the herniated orbital tissue, d: Width of inferior wall fracture, e: Length of inferior wall fracture, f: Degree of inferior displacement of the herniated orbital tissue. Area of fracture site – medial wall: π×a/2×b/2, inferior wall: π×d/2×e/2 Volume of herniated orbital tissue – medial wall: π×abc/6, inferior wall: π×def/6
jkaoms-37-205f2.tif
Fig. 3.
Positive correlation between the area of fracture and the degree of enophthalmos (E*). A: Medial wall fracture, B: Inferior wall fracture.
jkaoms-37-205f3.tif
Fig. 4.
Positive correlation between the volume of herniated orbital tissue and the degree of enophthalmos (E*). A: Medial wall fracture, B: Inferior wall fracture.
jkaoms-37-205f4.tif
Fig. 5.
Positive correlation between the area of fracture (medial+inferior) and the degree of enophthalmos (E*).
jkaoms-37-205f5.tif
Fig. 6.
Positive correlation between the volume of herniated orbital tissue (medial+inferior) and the degree of enophthalmos (E*).
jkaoms-37-205f6.tif
Table 1.
Site of fractures of orbital wall
Fracture site No. of patients (%)
Medial 31 (35.6)
Inferior 18 (20.7)
Medial & Inferior 38 (43.7)
Total 87 (100)
Table 2.
Site of operation according to fractures of orbital wall
Fracture site No. of patients (%)  
Medial   10 (33.4)
Inferior   3 (10.0)
Medial & Inferior only medial 3 (10.0)
  only inferior 7 (23.3)
  both 7 (23.3)
Total   30 (100)
Table 3.
Preoperative and postoperative values of enophthalmos measured by Oculus exophthalmometry
Degree of enophthalmos (mm) No. of patients (%)
Preoperative Postoperative
E=0 6 (20.0) 14 (46.6)
0<E<1 0 (0) 2 (6.7)
1≤E<2 6 (20.0) 9 (30.0)
2≤E<3 10 (33.3) 3 (10.0)
3≤E 8 (26.7) 2 (6.7)
Total 30 (100) 30 (100)

E=enophthalmos

Table 4.
EOM limitation
EOM limitation No. of patients (%)
Preoperative Postoperative*
Positive 5 (16.7) 1 (3.3)
Negative 25 (83.3) 29 (96.7)
Total 30 (100) 30 (100)

* the measured value after operation which passed at least more than 3 weeks

Table 5.
Diplopia
Diplopia No. of patients (%)
Preoperative Postoperative*
Positive 9 (30.0) 4 (13.3)
Negative 21 (70.0) 26 (86.7)
Total 30 (100) 30 (100)

* the measured value after operation which passed at least more than 3 weeks

Table 6.
Preoperative and postoperative values of enophthalmos measured by Oculus exophthalmometry
Degree of enophthalmos (mm) No. of patients (%)
Preoperative Postoperative
E=0 0 (0) 4 (66.6)
0<E<1 0 (0) 0 (0)
1≤E<2 0 (0) 1 (16.7)
2≤E<3 4 (66.7) 1 (16.7)
3≤E 2 (33.3) 0 (0)
Total 6 (100) 6 (100)

E=enophthalmos operation day: accident occurrence > 2weeks

Table 7.
EOM limitation
EOM limitation No. of patients (%)
Preoperative Postoperative*
Positive 2 (33.3) 0 (0)
Negative 4 (66.7) 6 (100)
Total 6 (100) 6 (100)

* the measured value after operation which passed at least more than 3 weeks operation day: accident occurrence > 2weeks EOM: extraocular muscle

Table 8.
Diplopia
Diplopia No. of patients (%)
Preoperative Postoperative*
Positive 1 (16.7) 0 (0)
Negative 5 (83.3) 6 (100)
Total 6 (100) 6 (100)

* postoperative: the measured value after operation which passed at least more than 3 weeks operation day: accident occurrence > 2weeks

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