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INTRODUCTION (cont.)ENOPHTHALMOS

diplopia and restriction of eye motility may be temporaryfindings that occur as a result of swelling, contusion, orintramuscular hematoma, and can resolve with time

the degree of enophthalmos of 2 mm is an indicator ofachieving satisfactory cosmetic results

enophthalmos may not be present immediately after the onsetof trauma. It cannot be easily detected in the earlyposttraumatic period because of orbital edema

the degree of enophthalmos was higher in patients with agreater extent of orbital wall fracture

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METHOD

PATIENT

Of the patients who visited the emergency roomof our medical institution during a periodRanging from 2009 to 2012, 81 had medial orbital

wall fracture detected incidentally

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METHOD (cont.)

STUDY METHODS

We performed a CT-scan of the medial orbitalwall fracture and thereby analyzed the extent offracture at a thickness of 2.5 mm based on thenon-overlapping, non-serial sections

The area of bone defects and the degree ofenophthalmos was measured using a picturearchiving and communication system (PACS).

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We measured the length ofthe line extending from thestarting point of the medialorbital wall fracture to its endusing the PACS at eachsection on coronal CT scans

and designated it asX .We multipliedXby theinterval of CT scanning andthereby obtained the unit areaof the bone defect .

By summing themeasurements of each area,we calculated the total area ofthe bone defect anddesignated it asA .

THE MEASUREMENT OF THE BONE DEFECT AREA

AT THE MEDIAL ORBITAL WALL FRACTURE SITE

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To measure the degree ofenophthalmos, we definedsome lines:

A, the distance between thelateral orbital rims of both eyes

B, the shortest distanceextending from the cornealcenter to line A

C, the distance between thelateral and medial orbitalmargins

D, the length of the linepassing through the corneal

center from its apex to line C

The globe position wasmeasured from thedifference in the value of D

THE MEASUREMENT AND COMPARISONOF THE DEGREE OF ENOPHTHALMOS

BETWEEN THE TWO SIDES

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METHOD (cont.)

STATISTICAL ANALYSIS

To identify the correlation between the degree ofenophthalmos and the area of the bone defect, weperformed a Pearsons correlation analysis. A P-value of

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RESULTS

BASELINE CHARACTERISTIC

The patients had a mean age of 50.212.3 years (range, 24-76 years)

Consisted of 75 men (92.6%) and 6 women (7.4%),showing a male predilection

There were 31 right-sided cases (38.3%) and 50 left-sidedones (61.7%).

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THE CORRELATION BETWEEN THE DEGREE OF

ENOPHTHALMOS AND THE AREA OF BONE DEFECT

A regression analysis showedthat a bone defect area of2.75 cm2 corresponded to 2mm of enophthalmosbasedon a formula of

E=0.705A+0.061 (E, thedegree of enophthalmos; A,the area of bone defect).

there were no cases in whichthe degree of enophthalmoswas higher than 2 mm whenthe area of the medial orbitalwall fracture was smaller than1.90 cm2

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DISCUSSIONOrbital fracture management:

1. Conservative

2. Surgical

The presence of diplopia, enophthalmos, or restriction of gazeare often used as criteria for repair of fractures of the orbital wall

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DISCUSSION (cont.)According to several studies, quantifying the area ofthe bone defect on CT scans in patients with orbitalwall fracture is essential for deciding on a treatmentapproach and is often used for deciding whether to

perform surgery

The degree of enophthalmos only had a correlation with thesize of the bone fracture (Jin et al, 2000)

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DISCUSSION (cont.)

We found a significantly larger number of patients with medial orbitalwall fracture had been left untreated than the number of those withinferior orbital wall fracture, because of:

The entrapment of the extraocular muscle between the fractures is lessfrequently seen in medial orbital wall fracture in inferior orbital wall fracture

It is easier for patients to adapt themselves to daily life when dealing withhorizontal diplopia from medial orbital wall fracture than with verticaldiplopia from inferior orbital wall fracture

Medial orbital wall fracture is less frequently complicated by sensorydisturbance and combined fracture than is inferior orbital wall fracture

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DISCUSSION (cont.)The degree of enophthalmos could be quantitatively

predicted based on the area of the bone defect even morethan six months after the onset of trauma. This will be of

help for clinicians in deciding on surgical treatment forpatients with medial orbital wall fracture who did notundergo early treatment. Nevertheless, the current data hasbeen collected from a long-term follow-up period of longer

than six months. It should therefore be noted that inaddition to the area of the bone defect, the discrepancy inthe location of the eyeball may also arise from such factorsas fat atrophy

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