Christensen Brian J, Zaid Waleed
Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2016 Jan;74(1):105-22. doi: 10.1016/j.joms.2015.09.023. Epub 2015 Sep 30.
In recent years, several studies have reported on practitioners' preferences for the treatment of orbital floor fractures, showing widely varying practice patterns. The purpose of the present study was to identify the practice patterns among oral and maxillofacial surgeons involved in the management of orbital floor fractures in the United States and compare them with the available published data.
An anonymous survey was created and electronically mailed to surgeons. We also reviewed the published data on orbital floor fractures using a PubMed and MEDLINE search. The responses to the survey were analyzed using descriptive statistics.
The factors that had the greatest influence on the surgeon's decision to operate were a defect size > 2 cm2, enophthalmos, entrapment, and persistent diplopia. The most common surgical approach reported was a preseptal transconjunctival approach (32.0%), followed by the subciliary (27.9%) and postseptal transconjunctival (26.2%) approaches. The most commonly reported implant for orbital reconstruction was titanium (65.4%), followed by Medpor (43.7%) and composite Medpor and titanium (26.4%). The review of the published data showed a consensus among many of the operative indications mentioned, including a large defect size, enophthalmos, clinical entrapment, and persistent diplopia.
Oral and maxillofacial surgeons in the United States have a wide range of practice habits in the management of orbital floor fractures. Although the quality of the available evidence is poor, it supports a consistent approach to the management of orbital floor fractures in terms of the indications and surgical approach. The choice of reconstructive material and timing of repair remain more controversial. A clear need exists for improvement in the available data to help guide and set standards of care for the specialties managing orbital floor fractures.
近年来，多项研究报告了从业者对眶底骨折治疗的偏好，显示出广泛不同的实践模式。本研究的目的是确定美国参与眶底骨折管理的口腔颌面外科医生的实践模式，并将其与已发表的可用数据进行比较。
创建了一份匿名调查问卷并通过电子邮件发送给外科医生。我们还使用PubMed和MEDLINE搜索回顾了关于眶底骨折的已发表数据。使用描述性统计分析对调查问卷的回复。
对外科医生手术决策影响最大的因素是缺损面积>2平方厘米、眼球内陷、眼球嵌顿和持续性复视。报告的最常见手术入路是睑缘前经结膜入路（32.0%），其次是睫毛下（27.9%）和睑缘后经结膜入路（26.2%）。报告的最常用于眶重建的植入物是钛（65.4%），其次是Medpor（43.7%）以及复合Medpor和钛（26.4%）。对已发表数据的回顾显示，在提及的许多手术指征方面存在共识，包括大的缺损面积、眼球内陷、临床嵌顿和持续性复视。
美国口腔颌面外科医生在眶底骨折管理方面有广泛的实践习惯。尽管现有证据质量较差，但在手术指征和手术入路方面支持对眶底骨折进行一致的管理方法。重建材料的选择和修复时机仍更具争议性。显然需要改进现有数据，以帮助指导和设定管理眶底骨折的各专业的护理标准。
