Surgical Timing of the Orbital "Blowout" Fracture: A Systematic Review and Meta-analysis

Olaf Ehlers Damgaard, Christian Grønhøj Larsen, Ulrik Ascanius Felding, Peter Bjerre Toft, Christian von Buchwald
Otolaryngology—Head and Neck Surgery 2016, 155 (3): 387-90

OBJECTIVE: The orbital blowout fracture is a common facial injury, carrying with it a risk of visual impairment and undesirable cosmetic results unless treated properly. Optimal timing of the surgical treatment is still a matter of debate. We set out to determine whether a meta-analysis would bring us closer to an answer to this question.

DATA SOURCES: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from January 1980 to August 2014. We applied the following inclusion criteria: isolated blowout fractures, presenting early and late surgery groups (<14 and >14 days). Patients were evaluated for diplopia and enophthalmos.

REVIEW METHODS: We followed the statements of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Pooled odds ratios were estimated with the fixed effects method of Mantel-Haenszel.

RESULTS: We identified 5 studies with available outcome data (N = 442). Patients in the late group showed an odds ratio of 3.3 (P = .027) for persistent postoperative diplopia as compared with the early group. We found no significant difference between the groups when assessing postoperative enophthalmos as an isolated symptom.

CONCLUSION: We found a significantly increased risk of persistent diplopia in patients who were operated >14 days after the trauma.

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