Setting A Classification and Management Protocol for Orbital Floor Fractures
Abstract
Background: Orbital floor fractures are among the most common maxillofacial injuries, frequently associated with zygomaticomaxillary fractures or occurring as isolated blow-out fractures. Clinical presentations vary from infraorbital hypoesthesia to enophthalmos, ocular motility restriction and diplopia. Management remains controversial regarding the optimal timing and surgical indications. Therefore, establishing a standardized classification and management algorithm is essential for improving outcomes.
Methods: This prospective study included patients with orbital floor fractures presenting to the Plastic Surgery Department. All patients were clinically evaluated for ocular motility, infraorbital nerve sensation, diplopia, and globe position. CT imaging was used to assess fracture type, displacement, size of defect, and herniation of orbital contents. Patients were classified based on fracture pattern, displacement, and defect size. Management ranged from conservative treatment to surgical reconstruction using cartilage grafts or titanium mesh according to the proposed protocol.
Results: Orbital floor fractures were most commonly associated with zygomaticomaxillary complex injuries. The clinical findings were diplopia, infraorbital hypoesthesia and enophthalmos. Displaced comminuted fractures and those with medium to large defects showed strong correlation with functional impairment. Surgical reconstruction demonstrated significant postoperative improvement in ocular motility, improvement of diplopia, and correction of enophthalmos. Conservative management was effective in minimally displaced fractures with small defect sizes.
Conclusion: The proposed classification and management protocol provides a systematic approach that helps identify patients who would benefit from surgical intervention and those suitable for conservative treatment. Applying this structured decision-making model enhances both functional and aesthetic outcomes while minimizing unnecessary surgical intervention.