Multidisciplinary evaluation of orbital floor fractures: dynamic MRI outcomes

ABSTRACT

Purpose

Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction.

Methods

In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements.

Results

This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient.

Conclusions

Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery.

KEYWORDS:

• Fractures of the orbital floor
• trauma complication
• MRI results
• eye motility deficit

Acknowledgments

The authors would like to thank Dr. Bellavita C. and Dr. Parisi B.M. for their valuable contribution to this study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.