Insights From the 100 Most Cited Articles on Orbital Fractures: A Bibliometric and Sentiment Analysis.

Background: Orbital fractures are common midfacial injuries that present complex challenges due to the anatomical and functional intricacies of the orbit. Understanding the evolution of surgical approaches and academic perspectives is essential to guide future research and multidisciplinary management.

Purpose: The purpose of this study was to describe the evolution of management of orbital fractures, highlighting scholarly focus to inform future research and multidisciplinary care.

Study design, setting, sample: This bibliometric study was conducted in January 2025. An electronic literature search was conducted on Web of Science Core Collection with search keys of orbital fracture and associated terms. Articles published between 1950 and 2024 were eligible for screening. Inclusion criteria were full-length, English-language articles, and ranking among the top 100 most-cited articles in the search results. Any literature not in English, editorial materials, letters, book chapters, meeting abstracts, notes, and reprints were excluded. The identified literature was analyzed using bibliometric and sentiment analysis.

Outcome variables: Information on the title, abstract, authors, year of publication, country of origin, primary institution, keywords, citation count, and number of references was retrieved from all identified articles. For the top 100 most cited articles, additional data were collected, including journal, corresponding author's specialty, and research topics.

Analyses: Sentiment analysis was performed on the top 100 most-cited articles using a natural language processing model to classify abstracts as positive, neutral, or negative, reflecting the overall tone of orbital fracture research. Bibliometric analyses and graphical presentations were generated using VOSviewer (Leiden University, The Netherlands).

Results: A total of 981 articles were identified, representing 66 countries. The United States was the top publishing country with a total of 326 (33.2%) articles, followed by South Korea and China. The top 5 institutions were Shanghai Jiaotong University, Harvard University, University of Maryland, Johns Hopkins University, and Helsinki University Hospital. Articles from Baylor College of Medicine were the most cited, with a total of 460 citations. For the 100 most-cited articles, the United States remained the leading country; however, our overlay map demonstrated a subtle shift toward other countries in recent years. Four clusters of keywords were identified, including "Epidemiology," "Management," "Complications," and "Fracture Types," suggesting research trends from diagnosis and management to materials and surgical planning. These articles most frequently appeared in the Plastic and Reconstructive Surgery (n = 9, 9%), the International Journal of Oral & Maxillofacial Surgery (n = 7, 7%), and the Journal of Craniofacial Surgery (n = 7, 7%), among a total of 46 journals. Corresponding author's specialty revealed that most were in the field of ophthalmology (n = 36, 36%), followed closely by oral and maxillofacial surgery (n = 24, 24%), and then otolaryngology-head and neck surgery (n = 15, 15%).

Conclusions and relevance: This bibliometric analysis reveals a growing interest in orbital fracture research, with increasing publications and citations over time. The research focus has evolved from diagnosis and management to surgical innovation, with a predominance of positive sentiment in highly cited literature. These findings offer valuable insights to inform future interdisciplinary collaboration and research focus.