Orbital Floor Fractures in Germany: Interdisciplinary Care without a Uniform Standard - Results of a Multicentre Survey.

Abstract

Objective: Surgical treatment of orbital floor fractures (OFF) in Germany is performed by several subspecialties. In an emergency setting, the question of necessity and urgency of surgery is frequently answered without ophthalmological consultation.

Purpose: The aim of this survey was to investigate the current management of OFF in German centres with emergency care, among the members of the national oculoplastic society (Section Ophthalmoplastic and Reconstructive Surgery [SORC]).

Methods: An 11-question questionnaire was sent to the main ophthalmology departments and members of the Section for Ophthalmic Reconstructive Surgery (SORC). Open (2), semi-open/multiple choice variant with multiple choice (6) and closed/dichotomous questions were used (3).

Results: The questionnaire response rate was 36.3% (37/102). Patients with OFF are treated by oral and maxillofacial surgeons at 86.1% of the sites and by ear, nose and throat specialists (in some cases interdisciplinary) at 25% of the sites. When the indication for surgery was made, the orthoptic status was only carried out at 72% of the sites and preoperative imaging was carried out at 75%. At 58.3% of the sites, OFF correction was also performed without any preoperative clarification by an ophthalmologist, predominantly in cases of polytrauma. The time of surgery was between 0 and 25 days, with a median of 7 days after the accident (8 ± 6 days).

Conclusions: In Germany, the initial surgical treatment of OFF is predominantly performed without prior ophthalmologic consultation and not by ophthalmologists. As early reconstruction can cause considerable individual ophthalmologic loss of function, it is important to promote interdisciplinary cooperation and, in particular, the corresponding oculoplastic care expertise in ophthalmology in order more reliably to avoid inadequate indications. The development of an interdisciplinary S2 guideline and the establishment of a national registry for orbital floor fractures appear to be urgently required to improve the quality of care.