A questionnaire survey for an orbital blowout fracture medical examination by Japanese otorhinolaryngologists

Objective

The status of orbital blowout fracture (BOF) management remains unclear due to the lack of standardized guidelines and limited data from individual facilities. Therefore, the present study aimed to assess current practices for diagnosing, treating, and evaluating BOF among Japanese otorhinolaryngologists.

Methods

A web-based questionnaire was distributed to 1,800 members of the Japanese Rhinologic Society and 621 designated clinical training hospitals. The survey was conducted between May 23 and August 31, 2024, and gathered information on diagnostic procedures, treatment approaches, post-operative evaluations, and complications associated with BOF surgery. Responses from 318 facilities, excluding duplicates, were analyzed.

Results

Out of 318 facilities, BOF surgery was performed in 129 by otolaryngologists. Computed tomography (CT) was the primary diagnostic modality used pre-operatively at all facilities, with Hess screen tests also being widely used (82.1 %). However, post-operative CT usage was significantly lower (55.8 %). Surgical indications were often decided within 1–2 weeks post-injury in most facilities. The most common complication was infra-orbital nerve disorder (19.4 %), followed by nasal bleeding (10.1 %) and anterior superior alveolar nerve disorder (9.3 %). An endoscopic endonasal approach was commonly performed for medial wall fractures, while a combined intra-/extra-nasal technique was frequently conducted for inferior wall fractures. Rigid reconstruction was performed on approximately 50 % of cases, using materials such as absorbable plates and autologous bone.

Conclusion

The present study highlighted significant variations in BOF management among facilities, indicating the need for standardization in evaluation methods and post-operative follow-up.