Jan Oliver Voss1, Stefan Hartwig2, Christian Doll3, Bodo Hoffmeister4, Jan-Dirk Raguse5, Nicolai Adolphs6. 1. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan.voss@charite.de. 2. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: stefan.hartwig@charite.de. 3. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: christian.doll@charite.de. 4. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: bodo.hoffmeister@charite.de. 5. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan-dirk.raguse@charite.de. 6. Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: nicolai.adolphs@charite.de.
Abstract
PURPOSE: The orbital compartment syndrome (OCS) constitutes a severe emergency, requiring immediate clinical diagnosis and surgical decompression. The key symptom is progressive visual impairment caused by an increase in intraorbital pressure, impairing the perfusion of relevant neurovascular and neurosensory structures. Intraorbital bleeding due to trauma and surgical intervention is known to be the main etiological factor. MATERIAL AND METHODS: A retrospective analysis of all patients affected by an OCS between January 1, 2012, and May 31, 2015, was performed. Patients' records were reviewed with regard to etiology, initial ophthalmologic status, fracture pattern, concomitant medication, surgical management, and postoperative outcome. The incidence of OCS was calculated based on the total number of craniomaxillofacial (CMF) emergencies. RESULTS: Within 3.5 years, a total of 18,093 CMF emergencies were registered. In 16 patients, an OCS was documented, corresponding to an incidence of 0.088%. The mean patient age was 67.31 ± 23.86 years, ranging from 22 to 102 years. The etiology varied, but trauma with subsequent intraorbital bleeding was the main cause. The use of anticoagulative medication was documented in 50% of the cases. In 14 patients, immediate surgical orbital decompression was performed: in 10 patients, vision could be preserved; in three patients, blindness resulted; and one patient was lost to follow-up. Two patients were managed without surgery. CONCLUSION: With regard to the total number of CMF emergencies, OCS is a rare condition. Early clinical diagnosis and surgical decompression are required to prevent permanent vision impairment. Anticoagulative medication must be considered as a predisposing factor for an orbital compartment syndrome in patients affected by periorbital trauma.
PURPOSE: The orbital compartment syndrome (OCS) constitutes a severe emergency, requiring immediate clinical diagnosis and surgical decompression. The key symptom is progressive visual impairment caused by an increase in intraorbital pressure, impairing the perfusion of relevant neurovascular and neurosensory structures. Intraorbital bleeding due to trauma and surgical intervention is known to be the main etiological factor. MATERIAL AND METHODS: A retrospective analysis of all patients affected by an OCS between January 1, 2012, and May 31, 2015, was performed. Patients' records were reviewed with regard to etiology, initial ophthalmologic status, fracture pattern, concomitant medication, surgical management, and postoperative outcome. The incidence of OCS was calculated based on the total number of craniomaxillofacial (CMF) emergencies. RESULTS: Within 3.5 years, a total of 18,093 CMF emergencies were registered. In 16 patients, an OCS was documented, corresponding to an incidence of 0.088%. The mean patient age was 67.31 ± 23.86 years, ranging from 22 to 102 years. The etiology varied, but trauma with subsequent intraorbital bleeding was the main cause. The use of anticoagulative medication was documented in 50% of the cases. In 14 patients, immediate surgical orbital decompression was performed: in 10 patients, vision could be preserved; in three patients, blindness resulted; and one patient was lost to follow-up. Two patients were managed without surgery. CONCLUSION: With regard to the total number of CMF emergencies, OCS is a rare condition. Early clinical diagnosis and surgical decompression are required to prevent permanent vision impairment. Anticoagulative medication must be considered as a predisposing factor for an orbital compartment syndrome in patients affected by periorbital trauma.
Authors: Jana A Bregman; Kalpesh T Vakharia; Oluwatobi O Idowu; M Reza Vagefi; F Lawson Grumbine Journal: Craniomaxillofac Trauma Reconstr Date: 2018-06-22