Correlation of preoperative computed tomography and postoperative ocular motility in orbital blowout fractures

Purpose: To determine a relationship between preoperative soft tissue disru ption and postoperative ocular motility in orbital blowout fractures. Methods: This retrospective cohort study reviewed 30 patients who met all c riteria: retrievable coronal computed tomography (CT) scans; internal fract ures of the orbital floor, with or without medial wall extension; preoperat ive diplopia; repair by a single surgeon; complete release of entrapped tis sues; and postoperative binocular visual fields (BVFs). Motility outcomes w ere quantified by one group of the authors, who measured the vertical fusio n within BVFs. Other authors analyzed CT scans, designating each fracture a s either A or B, based on lesser or greater soft tissue distortion relative to the configuration of bone fragments. The interval between trauma and su rgery was also determined. Results: Among the 15 patients with a postoperative motility outcome poorer than the median (86 degrees or less), four (27%) had A fractures; 11 (73%) had B fractures. Among the 15 patients with an outcome better than the med ian (88 degrees or more), 10 (67%) had A fractures; five (33%) had B fractu res. Differences were more defined away from the median. Among five patient s with B fractures and better than the median result, three (60%) had surgi cal repair during the first week after injury. Among the 11 patients with B fractures and less than the median result, one (9%) had repair during the first week. Conclusions: Postoperative motility is influenced by soft tissue-bone fragm ent relationships. Whether the outcome can be altered by earlier surgery in selected cases will be determined by prospective studies.