dc.description.abstract | Background of the study
Orbital fracture is a common injury accompanying mid-face trauma. The incidence of isolated
orbital fractures ranges from 4 to 16% of facial fractures. Combined with other injuries including
those of the zygomatico-maxillary-complex (ZMC) and those of the naso-orbito-ethmoidal (NOE)
complex, they account for 30 to 55% of all facial fractures. Orbital trauma can result in significant
functional and cosmetic defects and hence can be significantly disabling. The modal age of 20-40
years leads to reduced productivity and loss of manpower. Patients with fractures involving the
orbit often present with concomitant injuries of the eyeball and/or the surrounding extra-ocular
structures. Misdiagnosis or delayed diagnosis may result in debilitating complications such as
blindness, diplopia, permanent paresthesia, malocclusion and facial disfigurement.
Material and Methods
A descriptive prospective hospital-based study was carried out to determine the demographics,
aetiology, clinico-radiological features and management modalities among patients presenting
with orbital fractures (n=60) at the University of Nairobi Dental Hospital (UNDH) and Kenyatta
National Referral Hospital (KNH) in Nairobi, Kenya. A specially designed data collection tool
which was tested and calibrated was completed for all patients with confirmed orbital fractures.
All data were coded and entered into the statistical package for social sciences (SPSS) software
version 20 for analysis.
Results
Sixty patients (52 male, 8 females; p<0.05) with confirmed orbital fractures on CT scan were
recruited into the study. Orbital fractures occurred most frequently in the 21-40-year old age group
(80%, p<0.05). The self-employed group was the most affected occupational group (40%) whilst
the least affected was the formally employed group (3.3%). The distribution of orbital fractures
according to occupation was statistically significant (X2=23.500, p=0.000).The principal
aetiological factor was motor cycle crashes (MCCs) at 30 % particularly riders (21.6%) followed
by interpersonal violence (IPV) at 23.3%, public vehicle crushes (PVCs) at 20%, private vehicle
crushes (PVCs) at 10%, injury from flying objects at 10% and falls at 8.3%. All the cases of IPV
were male (n=14, p=0.071) particularly of the 20-30-yr old age (n=8) group. Clinical features
noted included peri-orbital oedema, subconjuctival haemorrhage (SCH), step deformity on the rim,
peri-orbital ecchymosis, trismus, eyelid laceration and avulsion, paresthesia, malar collapse and
telecanthus, blindness, diplopia and entrapment of extra-ocular muscles, enophthalmos, vertical
dystopia, exophthalmos and eyelid ptosis. The most commonly affected anatomical site was the
floor (75%) followed by the lateral wall (71.7%), infra-orbital rim (66.7%), zygomatico-frontal
suture (63.3%), medial wall (46.7%) and orbital roof (25%). Notably, 65% had zygomatic arch
fractures whilst 51.7% had ZMC fractures. In this study 5 patients had pure blow-out orbital
fractures whilst 55 patients had impure fractures. There were more fractures involving the left orbit
(n=28) than the right (n=14). Bilateral orbital fractures were seen in 18 patients. Indirect CT scan
findings included haemosinus (air-fluid level) in 47 patients, tissue emphysema, teardrop and
pneumocephalus. The relationship between haemosinus and orbital fractures was statistically
significant (p<0.05). More of the patients were managed conservatively (60%).
Conclusion
The present study has reaffirmed that RTCs, especially motor cycle crashes and IPV are the leading
cause of orbital injuries most commonly in the young males in their third and fourth decades of
life. Evidently, haemosinus as demonstrated on CT scanning together with peri-orbital oedema
and SCH constitute the clinical features most consistent with orbital fractures, most of which were
the impure variants. The left side was more affected than the right whilst the floor and the lateral
wall being the commonest sites of orbital fractures. Impure variants particularly zygomaticomaxillary-
complex fractures are by far more common than the pure variant. Depending on the
severity of the injury, orbital fractures can be managed either surgically or conservatively. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |