Massachusetts Eye and Ear Infirmary.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Ophthalmic Plast Reconstr Surg. 2019 Jan/Feb;35(1):53-55. doi: 10.1097/IOP.0000000000001162.
Introduction of a novel sensory grading system to assess the incidence and long-term recovery of infraorbital hypesthesia following orbital floor and inferior orbital rim fractures.
Patients who presented for evaluation of orbital floor and/or zygomaticomaxillary complex (ZMC) fractures between January 2015 and April 2016 were analyzed. Two-point subjective infraorbital sensory grading in 5 discrete anatomic areas was performed. Fractures were repaired based on traditional criteria; hypesthesia was not an indication for surgery. The sensory grading system was repeated a mean 21.7 months (range 18-28) after initial fracture.
Sixty-two patients (mean 41.8 years) participated in the initial symptom grading, and 42 patients (67.7%) completed the 2-year follow-up. Overall, 20 of 42 patients (47.6%) had some infraorbital hypesthesia. There were fewer with isolated orbital floor fractures versus ZMC fractures (31.8% vs. 68.4%; p = 0.019). Two years postinjury, 9.1% and 40.0% with isolated floor and ZMC fractures, respectively, had persistent sensory disturbance (p = 0.0188). Of patients with sensory disturbance on presentation, 71.4% with isolated floor fractures and 38.5% with ZMC fractures experienced complete sensory recovery (p = 0.1596). Patients with isolated floor fractures had improved recovery after surgery (100% vs. 33.3% recovery; p = 0.0410). Patients with ZMC fractures showed no difference in sensory prognosis between those repaired and observed.
In this pilot study, isolated orbital floor fractures carried a good infraorbital sensory prognosis, further improved by surgical repair. Zygomaticomaxillary complex fractures portended a worse long-term sensory outcome, unaffected by management strategy. This study validates the novel sensory grading system in post-fracture analysis.
介绍一种新的感觉分级系统，以评估眶下壁和下眶缘骨折后眶下感觉减退的发生率和长期恢复情况。
分析了 2015 年 1 月至 2016 年 4 月期间因眶底和/或颧骨上颌复合体（ZMC）骨折就诊的患者。在 5 个离散解剖区域进行两点主观眶下感觉分级。根据传统标准修复骨折；感觉减退不是手术指征。在初次骨折后平均 21.7 个月（范围 18-28）重复感觉分级系统。
62 例患者（平均年龄 41.8 岁）参与了初始症状分级，42 例患者（67.7%）完成了 2 年随访。总体而言，42 例患者中有 20 例（47.6%）存在眶下感觉减退。单纯眶底骨折患者少于 ZMC 骨折患者（31.8%比 68.4%；p=0.019）。骨折后 2 年，单纯眶底骨折和 ZMC 骨折患者分别有 9.1%和 40.0%持续感觉障碍（p=0.0188）。在就诊时存在感觉障碍的患者中，单纯眶底骨折患者有 71.4%和 ZMC 骨折患者有 38.5%完全感觉恢复（p=0.1596）。单纯眶底骨折患者手术修复后感觉恢复更好（100%比 33.3%恢复；p=0.0410）。ZMC 骨折患者的手术和观察治疗策略对感觉预后无影响。
在这项初步研究中，单纯眶底骨折眶下感觉预后良好，手术修复后进一步改善。ZMC 骨折预示着长期感觉预后更差，与治疗策略无关。本研究验证了骨折后分析中新型感觉分级系统的有效性。
