To Orbit or Not to Orbit: Using Pre-Operative Orbital Findings to Predict the Need for Orbital Exploration in Zygomaticomaxillary Complex (ZMC) Fractures

Introduction:

All ZMC fractures involve orbital fractures, with orbital floor fracture severity varying depending on the mechanism and energy of injury. Disruption of the orbital floor changes the orbital volume, increasing the risk of ocular signs/symptoms (e.g. enophthalmos, diplopia). This must be assessed at primary presentation to decide if primary orbital surgery should be performed alongside ZMC repair.

There is currently no standardised set of criteria to guide the decision-making process for orbital exploration in ZMC fractures. This study will evaluate whether the absence of ocular signs/symptoms pre-operatively can safely exclude the need for orbital exploration.

Method:

Data was retrospectively collected from a consecutive series of 98 patients who had ZMC fractures requiring ORIF intervention at the QEUH between 2021-2024. The presence/absence of ocular signs/symptoms at initial assessment was recorded. The cohort was then assessed to determine which patients underwent primary orbital exploration. Post-operative outcomes were reviewed, including whether any patients subsequently required secondary orbital surgery.

Results:

27 patients (28%) presented with ocular signs/symptoms, 6 of them underwent primary orbital surgery. Among the 71 patients (72%) who had no ocular findings at initial presentation, none required orbital surgery. Only 1 patient in the cohort required secondary orbital surgery, and this patient had also undergone primary orbital surgery.

Conclusion:

The absence of pre-operative ocular signs/symptoms may be a reliable indicator for excluding the need for orbital exploration. No patients who did not receive primary orbital exploration needed secondary orbital exploration, proving there were no late ocular complications from this approach.