Ocular motility alterations in orbital fractures: pre-post evaluation in maxillofacial surgical treatment

Purpose. The study aims to investigate the ability of maxillofacial surgery to reduce strabismus and improve ocular clinical symptomato- logy in patients with fracture of the medial or lateral floor of the orbit, or both, and to evaluate such abilities relative to the temporal distance between trauma and surgery. Materials and methods. 25 patients with traumatic diplopia were evaluated by CT, Goldman manual field of view, Hess-Lan- caster test, eye examination and orthoptic examination, before and after surgery. Results. We observed: a statistically significant reduction of the de- viation angle, both from close and long distance (P = 0.0054 and P = 0.0051 respectively) with a 38% reduction of the deviation from short distance and 54% from afar; a regression of diplopia in 20% of the surgically treated cases (CL from 0 to 39%), significant at the Mc Ne- mar test; a negative correlation with the time elapsed between the onset of the fracture and maxillofacial surgery (R = -0.26), even if the analy- sis did not show a statistical significance of the data (P = 0.2). Howe- ver, it is evident that the maximum improvement is observed only in cases operated within 5 months of the trauma, while the failures (wor- sening or persistence of diplopia) were observed only in the cases opera- ted later. Conclusion. We can state that the intervention reduces strabismus and improves ocular symptomatology, as it statistically significantly re- duces cases of diplopia; furthermore, it would seem preferable to inter- vene early, especially when damage to a muscular structure is suspected, even if the data do not allow definitive conclusions in this regard.