Orbital Fractures: A New CT-Based Protocol to Guide the Surgical Approach and Reconstruction Material Decision-Making

Preoperative computer-assisted planning and intraoperative navigation are becoming popular for orbital fracture treatment. However, not all institutions currently have access to these computer-aided applications. The authors present a simple and intuitive operative algorithm to guide orbital fracture reconstructions. The operative algorithm was based on linear measurements of orbital defects on high-resolution Computer tomography (CT) scans using specific axial, coronal, and sagittal plane images. The fractures were then divided into 3 types based on site and defect-size area. For each type, the authors suggested a surgical approach and material reconstruction. Between February 2022 and January 2023, 57 patients were treated according to the described CT-based protocol. The quality of reconstruction was classified as ideal, satisfactory, acceptable, and poor based on postoperative CT. Diplopia, enophthalmos, and postoperative complications were assessed. Fifty-seven patients were included. Forty-four (77.2%) patients were included in the type 1 group, 4 (7.01%) in the type 2 group, and 9 (15.79%) in the type 3 group. The reconstruction was considered ideal in 54 (94.7%) cases, satisfactory in 2 (3.5%), and acceptable in 1 (1.8%). No revision surgery was required. In all cases, preoperative diplopia was settled out, and only 1 patient reported postoperative enophthalmos. No complications occurred, with good clinical results and orbital symmetry. The linear CT measurement-based protocol is a simple and reliable workflow to guide the surgeon's choice of reconstruction material and surgical approach for primary orbital reconstruction. It allows good management of orbital trauma and could help standardize treatment decisions with an imaging technique available in all institutions.