{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:12:07Z","timestamp":1789999927183,"version":"4.0.1"},"reference-count":21,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Orbital defect size is widely used as a surrogate for fracture severity, yet a larger bony opening and direct injury to the extraocular apparatus are not the same. We tested whether defect magnitude provides comparable information about structural displacement and ocular motor dysfunction. Methods: Retrospective cohort of CT-confirmed orbital fractures at a level 1 trauma center, 2001\u20132023. Repeated records were adjudicated to one index injury per patient, yielding 1084 patients. The estimated two-dimensional defect area (hereafter, defect area) was calculated from maximum sagittal and coronal dimensions and modeled per 50 mm2 using logistic regression, restricted cubic splines, covariate-standardized probabilities, and bootstrap area under the curve (AUC). Results: Median defect area was 143.9 mm2 (IQR 82.6\u2013228.0). Per 50 mm2, adjusted odds increased for content herniation (odds ratio 1.37, 95% CI 1.28\u20131.48) and documented enophthalmos (1.45, 1.33\u20131.59) but not for extraocular movement abnormality (1.00, 0.92\u20131.09) or preoperative diplopia (1.01, 0.92\u20131.10). From 50 to 300 mm2, standardized probabilities rose by 35.9 and 26.3 percentage points for the structural phenotypes versus 0.2 and 0.6 for the functional phenotypes. Area-only AUCs were 0.670, 0.704, 0.500, and 0.508. Conclusions: Defect magnitude reflects structural displacement but shows little to no association with ocular motor dysfunction in this cohort.<\/jats:p>","DOI":"10.3390\/diagnostics16183043","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3043","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orbital Defect Size Reflects Structural Displacement but Not Ocular Motor Dysfunction: A Cohort Study of 1084 Patients"],"prefix":"10.3390","volume":"16","author":[{"given":"Tal","family":"Capucha","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7490-0501","authenticated-orcid":false,"given":"Ahmad","family":"Hija","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Chaim","family":"Ohayon","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6820-7126","authenticated-orcid":false,"given":"Andrei","family":"Krasovsky","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Amir","family":"Wolff","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Omri","family":"Emodi","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 HaAliya HaShniya Street, P.O. Box 9602, Haifa 3109601, Israel"},{"name":"Ruth and Bruce Rappaport, Faculty of Medicine, Technion\u2013Israel Institute of Technology, 1 Efron Street, Bat Galim, Haifa 3525433, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.otc.2023.05.002","article-title":"Current guidelines and opinions in the management of orbital floor fractures","volume":"56","author":"Pandya","year":"2023","journal-title":"Otolaryngol. Clin. N. 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Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.bjoms.2012.09.016","article-title":"Functional outcome after non-surgical management of orbital fractures\u2014The bias of decision-making according to size of defect: Critical review of 48 patients","volume":"51","author":"Kunz","year":"2013","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.amjoto.2013.02.006","article-title":"Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures","volume":"34","author":"Shah","year":"2013","journal-title":"Am. J. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1097\/SCS.0000000000003077","article-title":"Can a specific computed tomography-based assessment predict the ophthalmological outcome in pure orbital floor blowout fractures?","volume":"27","author":"Bruneau","year":"2016","journal-title":"J. Craniofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/PRS.0000000000008292","article-title":"Refining indications for orbital floor fracture reconstruction: A risk-stratification tool predicting symptom development and need for surgery","volume":"148","author":"Basta","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.ajo.2006.06.054","article-title":"Correlation between ocular motility and evaluation of computed tomography in orbital blowout fracture","volume":"142","author":"Furuta","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1136\/bjo-2025-327299","article-title":"Factors associated with diplopia before and after orbital blowout fracture reconstruction","volume":"109","author":"Oku","year":"2025","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.jcms.2018.06.008","article-title":"Correlation between increased orbital volume and enophthalmos and diplopia in patients with fractures of the orbital floor or the medial orbital wall","volume":"46","author":"Schonegg","year":"2018","journal-title":"J. Craniomaxillofac. 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Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"579","DOI":"10.3390\/tomography9020047","article-title":"Two-dimensional post-traumatic measurements of orbital floor blowout fractures underestimate defect sizes compared to three-dimensional approaches","volume":"9","author":"Taxis","year":"2023","journal-title":"Tomography"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/SCS.0000000000012681","article-title":"Volumetric assessment of blow-out fractures with automated segmentation benefits thinner computed tomography slice thickness: A retrospective case-control study","volume":"37","author":"Kormi","year":"2026","journal-title":"J. Craniofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/tvst.12.4.7","article-title":"Automatic identification and segmentation of orbital blowout fractures based on artificial intelligence","volume":"12","author":"Bao","year":"2023","journal-title":"Transl. Vis. Sci. Technol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3043\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:21:40Z","timestamp":1789996900000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":21,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183043"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183043","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,19]]}}}