Relationship between Enophthalmos and Orbital Volume Changes following Costal Cartilage Grafting for Traumatic...

Traumatic enophthalmos is a common complication of orbital wall fracture. Costal cartilage grafting is the preferred surgical approach for traumatic enophthalmos. However, widely used clinical guidelines have not been established regarding the optimal volume of costal cartilage grafts required to correct enophthalmos. This study aimed to quantitatively evaluate the changes in the orbital volume (OV) and enophthalmos before and after surgery in patients who underwent costal cartilage grafting, and to analyze the relationship between them.

The medical records of 12 patients with unilateral orbital wall fractures who underwent costal cartilage grafting between June 2012 and October 2020 were retrospectively analyzed. The OV and enophthalmos were measured using pre- and postoperative computed tomography scans. The OV difference (OVD) and OV ratio (OVR) between the affected and unaffected sides were calculated to assess their correlation with enophthalmos.

Among the nine patients in whom the OV was accurately measured, all demonstrated postoperative reductions in OVD, OVR, and enophthalmos. A significant positive correlation was observed between the OVR and enophthalmos postoperatively: R = 0.931 (p = 0.021). The analysis suggested that a volume of the transplanted costal cartilage that achieves a postoperative OVR of approximately 88% justly corrects the enophthalmos.

This study quantitatively confirmed that costal cartilage grafting reduces OVR and improves enophthalmos. The OVR may serve as a potential predictive metric for enophthalmos and facilitate graft volume planning for reconstructive surgery.