Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making

Article Article scientifique Article Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making eng 2022-03-25 2022-07 author Scolozzi Paolo 506389 author Gigon Edward 751193 author Schampel Petra 403595 author Steffen Heimo 844244 1198-1206 10.1016/j.joms.2022.03.016 35452602 0278-2391 https://www.sciencedirect.com/science/article/pii/S0278239122002361 Purpose: Orbital fractures (OFs) are common, but their association with concomitant traumatic ocular nerve palsy (TONP) is exceptional and may potentially cause confusing clinical pictures of oculomotor involvement. The purpose of the present study is to describe a series of patients with OFs and concomitant TONP following facial trauma and to evaluate clinical features, diagnostic pitfalls, and final functional outcome. Methods: The investigators designed and implemented a retrospective case series and enrolled a sample of patients with OFs and concomitant TONP who had been managed at the University Hospitals of Geneva between 2013 and 2020. The primary outcomes were clinical pitfalls (diagnosis of neurogenic vs restrictive ocular motility pattern at baseline) and final functional outcome (persistent symptomatic diplopia). Other study variables included demographic and injury related parameters. Results: The sample was composed of 10 patients with a mean age of 40.7 ± 12.3 years (range 21 to 53 years) and 80% were men. In all patients, the diagnosis of the neurogenic component accounted for the main diagnostic pitfalls associated to the baseline post-traumatic limitation of ocular motility and diplopia. Six patients (60%) had a full spontaneous recovery of their diplopia. Four patients (40%) had a partial recovery with residual diplopia. Of these 4 patients, 1 patient underwent corrective strabismus surgery, 2 had temporary occlusion of 1 eye, and 1 had Fresnel prisms. At the final follow-up visit none of the patients had persistent symptomatic diplopia. Conclusions: The present study has shown that OFs with concomitant TONP entail complex ocular motility patterns of neurogenic and/or restrictive origin; the diagnosis of the neurogenic component represents the main clinical pitfall that warrants a careful orthoptic evaluation to ensure the appropriate management; the final outcome was favorable with no persistent symptomatic diplopia in any of the patients. Adult Diplopia / diagnosis Diplopia / etiology Diplopia / surgery Female Humans Male Middle Aged Oculomotor Muscles Orbital Fractures / complications Orbital Fractures / surgery Paralysis / complications Retrospective Studies Young Adult Dewey 616.8 Dewey 617 57 Département de chirurgie 222 61 Département des neurosciences cliniques 226 false 555 Groupe Scolozzi Paolo (chirurgie maxillo-faciale et buccale) 896 582 Ophtalmologie expérimentale 925 Journal of oral and maxillofacial surgery 80 7 1f901991-af4a-4985-a7af-2f06ef08784f Article (Published version) Restricted 1-s2.0-S0278239122002361-main.pdf 956336 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making	Journal of oral and maxillofacial surgery			2022	224	1

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Schampel, Petra