Differences in Orbital Fracture Management Among Plastic, Facial Plastic, Oral Maxillofacial, and Oculoplastic...

Orbital floor fractures are among the most common facial fractures, yet no consensus guidelines exist for their management. Multiple surgeons from surgical specialties, including oculofacial plastic surgeons (OP), plastic surgeons, oral and maxillofacial surgeons, and facial plastic surgeons, routinely treat these injuries and may exhibit distinct clinical practice patterns.

An anonymous electronic survey was distributed between 2022 and 2023 to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the American Society of Maxillofacial Surgeons, the American Association of Oral and Maxillofacial Surgeons, and the American Academy of Facial Plastic and Reconstructive Surgeons. Respondents were queried about their clinical approaches to isolated orbital floor fractures.

A total of 389 surgeons completed the survey. OP were significantly more likely to delay intervention until the development of clinically significant enophthalmos (P < 0.001) and favorited longer periods of observation across multiple clinical scenarios (P < 0.05). The most used surgical approach was transconjunctival preseptal approach (53.0%), and the most frequently selected implant material was porous polyethylene-titanium (49.6%). Most respondents did not routinely use intraoperative or postoperative imaging; OP were the least likely to do so (P < 0.001). OP were also the least likely to use prophylactic antibiotics (P < 0.001).

Although general agreement exists among subspecialties regarding orbital floor fracture management, OP are more likely to delay surgery, forgo imaging, and avoid antibiotics. Areas of interspecialty variation highlight the opportunities for future research and the development of evidence-based guidelines.