Classification of the Lateral Orbital Wall Fracture and Its Clinical Significance

Purpose: The lateral orbital wall fractures have been previously classified by some authors. As there are some limitations in applying in their own classifications, we hope to present a refined classification system of the lateral orbital wall fracture and to identify the correlation between the specific type of the fracture and clinical diagnosis. Methods: The facial bone CT scans and medical records of 78 patients with the lateral orbital wall fractures were reviewed in a retrospective manner. The classification is based on the CT scan. In type I, the fracture and its segments are away from the lateral rectus muscle and in type II, they are next to or slightly pushing the muscle in axial CT scan. In type III, the fracture segments compress and displace the longitudinal axis of the muscle or the optic nerve in axial view of CT scan. Type IV fracture includes multiple fractures found around the orbital apex or optic canal in coronal view of CT scans of the type I and type II fractures. Results: The most common fracture pattern was type I(43.6%), followed by type IV(29.5%), type II(20.5%), and type III(6.4%). As diplopia and restriction of extraocular muscles were found in type I and II fractures, severe ophthalmic complications such as superior orbital fissure syndrome, orbital apex syndrome, and traumatic optic neuropathy were found in type III and IV fractures almost exclusively. Conclusion: We propose an easy classification system of the lateral orbital wall fracture which correlates closely with ophthalmic complications and may help to make further treatment plan. In Type III and IV fractures, severe ophthalmic complications may ensue in higher rates, so early diagnosis and treatment should be performed.

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