Blumer Michael, Rostetter Claudio, Johner Jean-Pierre, Ebner Julian J, Wiedemeier Daniel, Rücker Martin, Gander Thomas
Clinic for Oral and Maxillofacial Surgery, University Hospital Zurich, Switzerland.
Statistical Services, Center of Dental Medicine, University of Zurich, Switzerland.
Craniomaxillofac Trauma Reconstr. 2020 Sep;13(3):168-173. doi: 10.1177/1943387520922056. Epub 2020 Apr 28.
Concomitant ophthalmic injuries are common in patients with facial fractures, though frequency varies widely in the literature. Major ophthalmic injuries can have drastic consequences for patients, and permanent visual impairment cannot be prevented in all cases. This study analyzed the frequency and distribution pattern of associated ophthalmic injuries in patients who received operative treatment for fractures of the midface.
The clinical information system was searched for patients with midface fractures that were treated operatively between December 2014 and November 2017. Demographic, fracture-related, and ophthalmic data were assessed and statistically analyzed.
This study included 282 patients. The most common fracture types were zygomaticomaxillary complex fractures and orbital floor fractures. Falls and violence were the most common causes of fractures (43.3% and 24.5%, respectively). Chemosis and subconjunctival bleeding were the most common associated eye injuries. The most prevalent long-term eye injury was diplopia, which was identified in 18.4% of cases preoperatively. Postoperative diplopia persisted in 36 cases (12.8%) at 3-month follow-up. Optic neuropathy, enophthalmos, exophthalmos, and retrobulbar hematomas were identified infrequently.
Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. Major ophthalmic injuries, including retinal detachment, optic neuropathy, and retrobulbar hematomas, are identified less frequently. Special attention should be paid to patients with diplopia, as this condition may persist and have long-term occupational consequences. Therefore, close interdisciplinary collaboration is essential when treating patients with fractures of the midface to prevent permanent visual impairment.
面部骨折患者常伴有眼部损伤，尽管文献中报道的发生率差异很大。严重的眼部损伤可能给患者带来严重后果，且并非所有病例都能预防永久性视力损害。本研究分析了接受面中部骨折手术治疗患者中相关眼部损伤的发生率及分布模式。
检索临床信息系统，查找2014年12月至2017年11月期间接受手术治疗的面中部骨折患者。评估人口统计学、骨折相关及眼部数据，并进行统计学分析。
本研究纳入282例患者。最常见的骨折类型是颧上颌复合体骨折和眶底骨折。跌倒和暴力是骨折最常见的原因（分别为43.3%和24.5%）。球结膜水肿和结膜下出血是最常见的相关眼部损伤。最常见的长期眼部损伤是复视，术前18.4%的病例中发现有复视。3个月随访时，36例（12.8%）患者术后复视持续存在。视神经病变、眼球内陷、眼球突出和球后血肿较少见。
包括球结膜水肿和结膜下出血在内的轻度眼部损伤更常与面中部创伤相关。这些轻度损伤往往愈合快且无后遗症。包括视网膜脱离、视神经病变和球后血肿在内的严重眼部损伤较少见。应特别关注复视患者，因为这种情况可能持续存在并对职业产生长期影响。因此，治疗面中部骨折患者时，密切的多学科协作对于预防永久性视力损害至关重要。
