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Nawal M Shams1, Bashar Hassan, Ferris Zeitouni2

  • 1From the University of Maryland School of Medicine.

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Summary
This summary is machine-generated.

Traumatic optic neuropathy (TON) is linked to specific facial fractures, especially sphenoid sinus fractures. Steroid treatment for TON improves visual acuity faster and better than observation.

Keywords:
craniofacial traumaoptic nerve injuryorbital apex traumasteroid therapytraumatic optic neuropathy

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Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Trauma Surgery

Background:

  • Traumatic optic neuropathy (TON) can lead to permanent vision loss in up to 50% of patients.
  • Diagnosing and managing TON presents significant clinical challenges.
  • Identifying specific craniofacial fractures associated with TON is crucial for early detection and intervention.

Purpose of the Study:

  • To identify craniofacial fractures associated with traumatic optic neuropathy (TON).
  • To compare visual outcomes in TON patients managed with observation versus steroid-based treatment.

Main Methods:

  • Retrospective review of CT scans (2018-2022) for craniofacial fractures in acute facial trauma patients.
  • Analysis of TON patient outcomes (2013-2022) comparing steroid treatment (IV methylprednisolone) with observation.
  • Multivariate logistic and linear regressions used to assess fracture associations and treatment outcomes.

Main Results:

  • Out of 2374 patients with facial fractures, 21 (0.9%) had TON.
  • Sphenoid sinus fractures showed the highest odds of TON (aOR 25), followed by LeFort III (aOR 13) and NOE fractures (aOR 7).
  • TON patients treated with steroids had significantly better visual acuity improvement (62% vs. 33%) and a 57-day faster recovery compared to observation.

Conclusions:

  • Patients with sphenoid sinus fractures require careful examination for TON.
  • Steroid therapy at this institution leads to more rapid visual improvement and better final visual acuity in TON patients compared to observation.