Traumatic Brain Injury and Its Association With Orbital Fracture Characteristics and Repair

Traumatic brain injury (TBI) is common in up to 50% of patients with facial fractures. Orbital fractures account for 25% of all facial fractures. The authors sought to determine the prevalence and risk factors for TBI in patients undergoing orbital fracture repair (OFR) and assess the impact of TBI on surgical timing. A retrospective review of trauma patients who underwent OFR at a single trauma center from 2015 to 2020 was conducted. Excluded were patients <18 years old and those with unreported GCS on presentation. TBI was defined as GCS <15 or any neurological symptom on presentation. TBI was categorized into mild (GCS=14-15), moderate (GCS=9-13), and severe TBI (GCS=3-8). Our primary and secondary outcomes were the prevalence of TBI on presentation and duration from injury to surgery, respectively. Of the 200 patients analyzed, 99 (49.5%) had concomitant TBI on presentation. The most common neurological symptom on presentation was loss of consciousness n=80 (40%). Patients with TBI were significantly more likely to have an orbital roof n=11 (11.1%), n=4 (4.0%), P=0.048 and lateral wall fractures n=25 (25.3%), n=14 (13.9%), P=0.031 compared with patients without TBI. Patients with severe TBI were more likely to have delayed OFR-a significantly greater proportion of patients who had severe TBI had OFR after 60 days of injury compared with those without TBI or with mild TBI 5 (39%), 12 (12%), 4 (5%), P=0.032. Craniofacial surgeons must suspect and screen for TBI in patients presenting with facial trauma, especially those with orbital roof and lateral wall fractures.