In this study, researchers measured spontaneous improvements that occurred in patients who were treated conservatively for blowout fractures.
Study design
This prospective, noncomparative case series included 41 patients (44 orbits) who sustained an orbital blowout fracture but did not undergo surgery. Patients were scanned by CT at presentation and during follow-up.
Outcomes
CT scans revealed bony contour changes in all orbits during follow-up (mean 4.6 months, range 1–15 months). These changes included smoothening of the orbital contour (89%), joining of bony edges (91%) and reduction in herniation of orbital contents (66%).
Nearly all orbits (93%) had neobone formation. Calculations showed orbital and fracture volumes were significantly reduced in approximately 91% and 94% of orbits, respectively.
Clinical significance
This study adds additional evidence that supports conservative treatment of orbital fractures. Once again, the age-old dictum that fractures should be treated at 10 and 14 days is questioned.
As treatment of orbital fractures continues to evolve, conservative treatment has gained additional support. This study showed many patients demonstrate radiological improvements despite conservative treatment.
The accompanying editorial to this manuscript argues against early surgical intervention, with the exception of trapdoor fractures in children. The authors of the editorial instead advocate for prolonged observation to allow resolution of diplopia or development of cosmetically significant enophthalmos. Delayed surgery, according to the authors, is still likely to achieve full restoration of functional motility with no increased risk of surgical complications.