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.

Conclusion for Practitioners

Already known:

• Surgical treatment of orbital floor fractures is performed in Germany by various specialist disciplines.

• The necessity and the optimal timing of operative treatment are the subject of controversial debate in the literature.

• So far, there has been no systematic overview of the reality of care and interdisciplinary cooperation in the treatment of orbital floor fractures in Germany.

Newly described:

• In Germany, surgical treatment of orbital floor fractures is predominantly performed by oral and maxillofacial surgeons, in 40% of cases without prior ophthalmological consultation.

• The indication for surgery is made at 28% of sites without consideration of the orthoptic status and at 25% without preoperative imaging.

• Our survey results underline the urgent need for an interdisciplinary S2 guideline for the treatment of orbital floor fractures with the participation of all relevant disciplines.

• In addition, a national register for orbital floor fractures should be established to allow systematic recording of treatment pathways, treatment decisions and long-term outcomes. Such a registry could provide valuable data for clinical decision-making and contribute to quality assurance in care.

Fazit für die Praxis

Bereits bekannt:

• Die chirurgische Versorgung von Orbitabodenfrakturen wird in Deutschland von verschiedenen Fachdisziplinen durchgeführt.

• Die Notwendigkeit und der optimale Zeitpunkt einer operativen Versorgung werden in der Literatur kontrovers diskutiert.

• Bisher fehlte ein systematischer Überblick über die Versorgungsrealität und die interdisziplinäre Zusammenarbeit bei der Behandlung von Orbitabodenfrakturen in Deutschland.

Neu beschrieben:

• In Deutschland erfolgt die chirurgische Versorgung von Orbitabodenfrakturen überwiegend durch MKG-Chirurgen, in 40% der Fälle ohne vorherige augenärztliche Konsultation.

• Die Indikation zur Operation wird an 28% der Standorte ohne Berücksichtigung des orthoptischen Status und an 25% ohne präoperative Bildgebung gestellt.

• Unsere Umfrageergebnisse unterstreichen die dringende Notwendigkeit einer interdisziplinären S2-Leitlinie zur Versorgung von Orbitabodenfrakturen unter Beteiligung aller betroffenen Fachdisziplinen.

• Zudem sollte ein nationales Register für Orbitabodenfrakturen etabliert werden, um eine systematische Erfassung der Behandlungswege, Therapieentscheidungen und Langzeitergebnisse zu ermöglichen. Ein solches Register könnte wertvolle Daten für die klinische Entscheidungsfindung liefern und zur Qualitätssicherung in der Versorgung beitragen.

Keywords

orbit - fracture - surgery - survey - treatment

Publication History

Received: 07 April 2025

Accepted: 17 June 2025

Accepted Manuscript online:
24 June 2025

Article published online:
18 September 2025

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