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Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management

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Abstract

Purpose

Blindness in craniomaxillofacial (CMF) injuries may occur due to acute orbital compartment syndrome (AOCS). Primarily, this article aimed to retrospectively review our 4-year experience in the management of patients diagnosed with AOCS secondary to an orbital hematoma (OH). Furthermore, this paper included up-to-date information regarding the prevalence, diagnosis, management, and prognosis of AOCS.

Materials and methods

We retrospectively screened the medical records of patients who visited our hospital’s emergency department (ED) and were examined by an oromaxillofacial surgeon for CMF injuries, between September 1, 2013, and September 31, 2017. The electronic hospital’s database was searched to retrieve all cases of CMF trauma admitted or referred to our clinic during this period.

Results

Over a 49-month period, 3,514 patients were managed for CMF injuries in ED; 9 cases (0.26%) were attributed to OCS caused by an OH. This group comprised 5 males and 4 females aged between 32 and 91 years old (mean 65.7, median 70). Seven out of 9 patients were subjected to lateral canthotomy and inferior cantholysis (LCIC), whereas septolysis was applied in 6 of them. Sight was preserved in 3 out of 8 patients (37.5%), since a patient died from a serious intracranial injury. Seven out of 9 patients (77.7%) of the OCS group had a history of hypocoagulable state.

Conclusions

LCIC, septolysis, and careful dissection within inferotemporal orbital quadrant constitute a reliable approach for emergent orbital decompression. CT scan offers differential diagnosis of acute traumatic proptosis, but it should preferably follow LCIC. In case of OHs without pupillary abnormalities and/or impairment of visual acuity, close monitoring allowing for timely interventions is highly recommended to patients with a history of hypocoagulative status, (uncontrolled or severe) hypertension, head trauma, and decreased level of consciousness or in elderly patients suffering from dementia or without rapid access to follow-up medical care. Clinicians dealing with ED services must maintain high skills in AOCS diagnosis and in LCIC execution.

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Acknowledgements

We acknowledge Professor Nikolaos Papadogeorgakis, MD, DDS, MSc, PhD, Head of OMFS Clinic of Evaggelismos, General Hospital of Athens, Athens, Greece (2014–2018).

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Authors and Affiliations

  1. Attikon” University General Hospital, Chaidari, Medical School of Athens, Athens, Greece

    Papadiochos I

  2. School of Dentistry, Athens, Greece

    Petsinis V & Goutzanis L

  3. OMFS Clinic of “Evaggelismos” Gereral Hospital, Athens, Greece

    Petsinis V & Bourazani M

  4. Department of Plastic Surgery, Hygeia Hospital, Athens, Greece

    Sarivalasis S-E

  5. OMFS Clinic of “Panagiotis and Aglaia Kyriakou” Children’s Hospital of Athens, Athens, Greece

    Strantzias P & Goutzanis L

  6. Private Practice, Athens, Greece

    Tampouris A

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The 1st, 3rd, 4th, 6th, and 7th authors were members of OMFS Clinic of “Evaggelismos” Gereral Hospital, Athens, Greece between 2013 and 2018

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I, P., V, P., S-E, S. et al. Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management. Oral Maxillofac Surg 27, 101–116 (2023). https://doi.org/10.1007/s10006-021-01036-9

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