Ophthalmic Injuries in Patients With Zygomaticomaxillary Complex Fractures Requiring Surgical Repair

Jamal, Basem T.; Pfahler, Scott M.; Lane, Kate A.; Bilyk, Jurj R.; Pribitkin, Edmund A.; Diecidue, Robert J.; Taub, Daniel I.

doi:10.1016/j.joms.2008.12.035

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 5 , Pages 986-989, May 2009

Ophthalmic Injuries in Patients With Zygomaticomaxillary Complex Fractures Requiring Surgical Repair

Basem T. Jamal, BDS
- Formerly, Chief Resident, Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA; and Currently, MSD Student in Cancer Research, OMFS and Cell Biology Departments, Boston University Medical Center, Boston, MA
- Address correspondence and reprint requests to Dr Jamal: Boston University Medical Center, Department of Molecular and Cell Biology, 715 Albany Street, EVANS 401, Boston, MA 02118
Scott M. Pfahler, DO
- Wills Eye Institute, Philadelphia, PA
Kate A. Lane, MD
- Wills Eye Institute, Philadelphia, PA
Jurj R. Bilyk, MD
- Associate Professor, Oculoplastic Department, Wills Eye Institute, Philadelphia, PA
Edmund A. Pribitkin, MD
- Associate Professor, ENT Head and Neck Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA
Robert J. Diecidue, DMD, MD, MSPH
- Chairman, Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA
Daniel I. Taub, DDS, MD
- Assistant Professor, Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA

Purpose

Injuries to the middle third of the face commonly destroy the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7% and 90.6% in reported series. This article is a retrospecitve, descriptive case study assessing the spectrum and incidence of ophthalmic involvement in patients presenting with zygomaticomaxillary complex (ZMC) fractures.

Patients and Methods

Ninety-six patients with ZMC fractures who were surgically treated in 1 academic institution between 1996 and 2006 were assessed pre- and postoperatively by the same oculoplastic surgeon and were included in the study. All patients had a thorough ophthalmologic examination that included assessment of visual acuity, pupillary reactivity, anterior and posterior segment examination, and extraocular motility. In cases of optic neuropathy, automated perimetry was also performed. The variables reviewed included patients' age, gender, mechanism of injury, visual acuity, pupillary reactivity, extraocular motility, presence or absence of diplopia, ocular and orbital findings, and intraorbital hypoesthesia.

Results

Gender distribution of the patients was 88% male, with a mean age of 36 years. The most common etiology of trauma was assult (56%), followed by falls (21%). Most patients (66.6%) sustained minor ocular injuries such as subconjuctival hemorrhage, iris sphincter tear, and corneal abrasion. Subconjunctival hemorrhage was the most common minor injury, accounting for 55% of the cases. Major injuries such as ruptured globe and retinal hemorrhage occurred in 10% of the patients. Orbital findings such as restriction of extraocular movement occurred in 15% of cases. Symptomatic diplopia was noted in 16% of the patients and traumatic optic neuropathy occurred in 6%. Diplopia significantly improved in the first 3 postoperative months, dropping from a preoperative incidence of 16% to 2%.

Conclusion

Comminuted ZMC fractures had been reported to be associated with a signficantly higher incidence of visual sequelae than other forms of midfacial injury. A 10% incidence of major or blinding injuries and a 6% incidence of traumatic optic neuropathy are significant, and warrants a prompt ophthalmologic examination of all patients with ZMC fractures as quickly as possible, and always preoperatively in injuries necessitating surgical repair.