Peacock Zachary S, Boulos Toufic, Miller John B, Gardiner Matthew F, Chuang Sung-Kiang, Troulis Maria J
Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
Research Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2014 Aug;72(8):1533-40. doi: 10.1016/j.joms.2014.03.008. Epub 2014 Mar 24.
To determine whether formal ophthalmology evaluation is necessary after operative repair of orbital fractures and the association of an ocular injury to the severity of facial injury.
This was a retrospective cohort study of patients with orbital fractures undergoing operative repair from 2005 to 2013. Subjects were included if they had undergone reconstruction of orbital floor fractures and had data from pre- and postoperative examinations by the oral and maxillofacial surgery and ophthalmology services available. The predictor variables included the service performing the ocular examination (oral and maxillofacial surgery or ophthalmology) and the number of fractures present. The outcome variables were the presence of pre- and postoperative ocular injuries. Logistic regression models were used to determine the relationship of the fracture number to ocular injury.
A total of 28 subjects had undergone repair of orbital fractures with preoperative and postoperative examinations performed by both services. Preoperative ocular injuries were found in 17 of the 28 subjects. Those detected by oral and maxillofacial surgeons were limited to changes in visual acuity, pupillary response, and extraocular muscle dysfunction in 11 subjects. Two subjects had new postoperative ocular findings that were considered minor and did not alter management. An increasing number of facial fractures was associated with an increased risk of ocular trauma. Those with 3 or more fractures had an odds ratio of 14.625 (95% confidence interval, 2.191 to 97.612, P = .006) for the presence of ocular injury.
Operative repair of orbital fractures did not lead to new ocular injuries that would change the management. Thus, those without preoperative ocular injuries will not require a formal postoperative ophthalmology examination. However, the subjects with more fractures had an increased likelihood of ocular injuries.
确定眼眶骨折手术修复后是否需要进行正式的眼科评估，以及眼外伤与面部损伤严重程度之间的关联。
这是一项对2005年至2013年接受眼眶骨折手术修复患者的回顾性队列研究。纳入标准为接受眶底骨折重建且有口腔颌面外科和眼科术前及术后检查数据的患者。预测变量包括进行眼部检查的科室（口腔颌面外科或眼科）以及骨折数量。结果变量为术前和术后眼外伤的存在情况。采用逻辑回归模型确定骨折数量与眼外伤的关系。
共有28名患者接受了眼眶骨折修复，两个科室均进行了术前和术后检查。28名患者中有17名存在术前眼外伤。口腔颌面外科医生检测到的眼外伤仅限于11名患者的视力变化、瞳孔反应和眼外肌功能障碍。两名患者术后出现新的眼部表现，被认为较轻微，未改变治疗方案。面部骨折数量增加与眼外伤风险增加相关。有3处或更多骨折的患者发生眼外伤的比值比为14.625（95%置信区间，2.191至97.612，P = .006）。
眼眶骨折手术修复未导致会改变治疗方案的新的眼外伤。因此，术前无眼外伤的患者术后无需进行正式的眼科检查。然而，骨折较多的患者发生眼外伤的可能性增加。
