Orbital Index: A Novel Comprehensive Quantitative Tool for Prediction of Delayed Enophthalmos in Orbital Floor Fracture Management.

Autor:	De Ruiter BJ; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Kotha VS; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Lalezar FD; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Swanson MA; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Kumar AR; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Barmettler A; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Prendes MA; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine., Davidson EH; From the Departments of Plastic and Reconstructive Surgery and Ophthalmology and Visual Sciences, University Hospitals, Case Western Reserve University; and Division of Plastic and Reconstructive Surgery and Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2022 Sep 01; Vol. 150 (3), pp. 625e-629e. Date of Electronic Publication: 2022 Jul 01.
DOI:	10.1097/PRS.0000000000009428
Abstrakt:	Summary: Early identification of surgical indication is critical to optimizing outcomes in orbital floor fracture management. However, identifying those at risk for delayed enophthalmos and requiring subsequent repair has remained a challenge. This study aimed to validate the Orbital Index, a prediction tool using computed tomography to stratify risk for delayed enophthalmos and establish a threshold for repair. The Orbital Index stratifies fractures by size, location, and inferior rectus rounding (a surrogate for fascioligamentous sling disruption) on a scale 0 to 6. A 22-year (1998 to 2020) multi-institution analysis of unilateral isolated orbital floor fractures was performed. Index scores were assigned to each scan, unoperated patients invited for blinded Hertel exophthalmometry assessment, and enophthalmos measurements correlated with Index scores. Interobserver scoring reproducibility was assessed with weighted Cohen kappa. Preintervention and postintervention Likert scale surveys were administered to determine whether this tool improved understanding and communication. The Orbital Index demonstrated high fidelity and interobserver reproducibility and identified a score of four or greater as a surgical threshold. Of 1769 computed tomography scans, 395 met criteria and were included for analysis. Eighty of 395 were managed operatively (operative rate, 20.3 percent). Of 315 patients managed nonoperatively, 41 (13.0 percent) agreed to follow-up evaluation and 28 (68.3 percent) were found to have enophthalmos. Unoperated patients with an Orbital Index score of 4 or higher were more likely to have enophthalmos than those with a score of 3 or less ( p = 0.001). The mean weighted Cohen kappa was 0.73, corroborating reproducibility. Communication ( p = 0.0003) and ability to correctly identify surgical need ( p = 0.01) were improved with use of this tool. The Orbital Index is a reproducible tool to stratify risk for enophthalmos in orbital floor fracture management. (Copyright © 2022 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu