[Posttraumatic enophthalmos correction by bone graft: Why the unpredictable results?]

Area of Science:

• Ophthalmology
• Plastic Surgery
• Medical Imaging

Background:

• Post-traumatic enophthalmos presents complex cosmetic challenges.
• Accurate assessment of orbital volume and soft tissue changes is crucial for successful reconstruction.

Purpose of the Study:

• To calculate the required volume of parietal bone graft for enophthalmos correction.
• To determine optimal graft placement within the orbit.
• To investigate the role of soft tissues in post-traumatic enophthalmos outcomes.

Main Methods:

• Retrospective analysis of 29 surgeries in 24 patients.
• CT scans used to measure orbital bone and soft tissue volumes, and graft parameters.
• Comparison of graft volumes and locations between groups with good and insufficient cosmetic results.

Main Results:

• Average orbital bone volume in enophthalmos was 24.76 cm³, with 17.12 cm³ of soft tissue.
• Retro-lens distance proved to be the most reliable enophthalmos measurement.
• A significant increase in soft tissue volume was observed in traumatized orbits (P=0.0008).

Conclusions:

• The surprising finding of increased soft tissue volume contradicts theories of scar retraction.
• Potential factors influencing aesthetic results include increased fat density, connective tissue changes, and ligamentous weathering.
• Further research using MRI, ultrasound, and pathological studies is recommended to understand orbital pathophysiology in enophthalmos.