CLASSIFICATION OF THE SEVERITY OF TRAP-DOOR TYPE ORBITAL FLOOR FRACTURES

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  • ZENNO Makoto
    Department of Ophthalmology, Showa University School of Medicine
  • ONDA Hidetoshi
    Department of Ophthalmology, Showa University School of Medicine
  • UEDA Toshihiko
    Department of Ophthalmology, Showa University School of Medicine
  • KOIDE Ryohei
    Department of Ophthalmology, Showa University School of Medicine
  • TAKAHASHI Haruo
    Department of Ophthalmology, Showa University School of Medicine

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Other Title
  • Orbital floor fracture（Trap door type）の重症度分類
  • Orbital floor fracture(Trap door type)ノ ジュウショウド ブンルイ

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Abstract

Three types of visual disturbance––diplopia, abnormal eye movement, and reduced field of fixation––were examined in patients with trap-door type orbital floor fractures before and after surgery, with the aim of classifying fracture severity on the basis of abnormality profile. Of 147 cases of orbital floor fracture diagnosed at the Department of Ophthalmology, Showa University between January 1, 2008 and December 31, 2008, 49 cases without medial wall fracture confirmed by computed tomography (CT) were examined. Diplopia was examined using the confrontation test, while abnormal eye movement and reduced field of fixation were examined using the Hess red-green test and binocular visual field test (BVF), respectively. Horizontal or vertical abnormalities detected by Hess were defined as horizontal or vertical deviations of 5 degrees or greater, respectively. The abnormal field of fixation was defined as binocular diplopia within the central 5 degrees of the field as assessed by BVF. The preoperative results of 46 of 49 patients were classified into five groups. When the Hess area was calculated using the 30° lines on the screen, and when the average ratios of the impaired side to the normal side of the eye (Hass area ratio: HAR%) were compared between the five groups, the average HAR% was lower in the group with more types of detected abnormalities. Examining the four types of abnormalities enables classification of the severity of trap-door type orbital floor fractures into 5 groups. The severity levels classified by our method were in good agreement with those classified by HAR%, suggesting that our classification method will be useful for predicting the prognosis and determining the indications for surgery, as well as for preoperative assessment, in patients with trap-door type orbital floor fracture.

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