Orbital Volume Differences: Indication for Surgery in Blow Out Fractures

Objective In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. We wanted to evaluate whether a relative change in volume would function as an indicator for surgical vs nonsurgical treatment of orbital floor fractures. Method This was a follow‐up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. The volume of the orbital contentwas calculated digitally from the patients’ CT scans at the time of their injury. 18 norms were included as controls. Results Five of 23 patients showed 2 to 4 mm enophthalmus, and only 3 of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmus. No statistical correlation supporting the supposition that 1 mL herniated orbital content would result in 1mm enophthalmus was found. Conclusion The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmus is unclear.