The mean length of hospitalization after the operation was 9.63 ± 5.23 days with

extremes of 4 days and 25 days. There had been no intraoperative incident. Periorbital edema and ecchymosis were noted in all patients immediately postoperatively and progressed favorably with symptomatic treatment. The late postoperative complications noted were infections of the operative site objectified in two patients (4.55%) and who were treated with antibiotic therapy adapted to the germs involved.

The postoperative check-up was performed at 15 days, 6 weeks, 3 months, 6 months and 12 months after the operation for clinical and radiological checks. Six patients (13.65%) presented sequelae such as diplopia, enophthalmos and suborbital hypoaesthesia (Table 6). These patients did not come for check-up after the sixth week postoperative.

This is a descriptive retrospective study, carried out on the epidemiological, clinical

and therapeutic aspects of 51 cases of orbital floor fractures collected in the ENT-CCMF department of the University Teaching Hospital of Lomé (CHU SO). The sample of 51 patients seems to be underestimated since some incomplete files were rejected due to the absence of the key variables necessary for the study. In addition, for personal reasons, some patients are taken care of in private clinics in the city. The other limitation of this study is that it could have concerned the Ophthalmology department of CHU SO where some patients could consult directly because of eye disorders related to these traumas. But anyway, most of these patients seen in the ophthalmology department are sent back to the maxillofacial surgery department, after consultation for management of disorders related to orbital bone trauma. In the University Teaching Hospital of Lomé, there is no possibility to make Hess Lancaster test, because of lack of materials. Notwithstanding these extenuating circumstances, the results of this work have undeniably allowed taking stock of these traumas and their management in Togo.

The hospital frequency of orbital floor fractures in our series was 9.24% of all maxillofacial injuries. This prevalence is almost similar to those reported by Biaou et al. in Benin in 2003 [2] and by Méda et al. in Burkina faso in 2001 [5]. In the Western literature, the frequency of orbital floor fractures is higher and varies from 10% to 20% [3] [4] [11]. These relatively low frequencies in African studies could be explained on the one hand by insufficient health care centers, and on the other hand by financial difficulties which force some patients to seek treatment at home or from traditional healers.

With an average age of 35 years (extremes: 17 years and 63 years), the age group most affected in our series was 30 - 39 years (35.30%). Similar results are reported by several authors in the literature [2] [5] [11]. These results lead to the conclusion that maxillofacial trauma is the prerogative of young adults who are most often males. In fact, in our series, the male sex was predominant, with a sex ratio of 7.5. Biaou et al. [2] in Benin reported the same sex ratio. Several studies have reported this male predominance in maxillofacial trauma in general, even if it seems less important. Munos et al. [12] and Gear et al. [13] reported 4. This high predominance of young adult males could be explained by the fact that it is the most active age group, especially in the most exposed professions: Taxi-motorcycle drivers, taxis, construction workers trades; to which they sometimes work in drunkenness conditions (27.45%).

In our study, as in most African studies, road accidents are the primary causes of orbital floor fractures [2] [5]. However, in Western countries, other etiologies are more likely to cause these lesions. Thus, sports accidents were ranked first according to Tang et al. [14] in Canada and Piombino et al. [15] in Italia. For Senese et al. in Belgium [16] , assaults were in the majority. Many factors could explain this high frequency of road accidents in the African studies. In fact, habits such as the compulsory wearing of helmets and seat belts by road users, and road safety measures are not observed in Africa. In addition, the growth of public transport (high-speed trains, subways, buses, etc.) is still rudimentary there. To these different causes can be added the increase in the vehicle fleet with the rapid development in recent decades of the use of two-wheeled vehicles; which is not followed by the modernization of road infrastructures [2] [5].

The diagnosis of orbital floor fractures is suspected based on clinical signs, and confirmed by radiological explorations. The clinical examination should begin with the exploration of ocular motility. This exploration should be supplemented by the Hess Lancaster test for diplopia [7]. The limitation of eye movements was most often in the vertical upward gaze, sometimes in the outward gaze, thus reflecting incarceration of the periorbital soft parts [2] [7]. Its frequency in our series is 25.49%. It represented the most important sign in the series of Tang et al. [14] with a frequency of 45%. As for diplopia, it was noted in 31.37% of our patients. Its frequency in the literature is estimated between 25 to 75% [14] [15]. Enophthalmos was found in 29.41% of cases in our study. It is thought to be linked to an increase in orbital volume or the displacement of the soft contents of the orbit in the maxillary sinus. Its frequency is high in blow-out fractures and varies according to the studies [14] [15]. Thus, diplopia, enophthalmia and limitation of eye movements are the main signs of fractures of the floor of the orbit. They are often associated with hypoesthesia in the area of the infraorbital nerve [9] [17]. For medico-legal reasons, Gas et al. [18] recommend their systematic research before and after any surgery.

Apart from these major signs, there are less specific ophthalmologic signs which are frequently encountered in trauma to the orbit. The most frequent manifestations in our study were subconjunctival hemorrhage (25.49%), conjunctival hyperemia, globe sore, edema, and upper eyelid sore. These clinical manifestations have been reported by various authors and are thought to be linked to the close relationship of the eye to the orbital floor [2] [18].

The facial CT-Scan with axial and coronal slices and images of two and three-dimensional reconstructions allows diagnosis and complete lesions assessment [10] [18]. Comparative studies between standard radiography on the one hand [10] and MRI on the other hand [19] with CT-Scan have shown the superiority of the latter in bone lesions of the floor of the orbit. For Gas et al. [18] , the indication for facial CT-Scan should be very broad or even almost systematic in any trauma of the face to minimize forgeting lesions which could lead functional and/or aesthetic disorders. The CT-Scan makes it possible to specify the therapeutic indications and the type of intervention [19]. As for the incidence of Blondeau, its importance has greatly diminished in favor of recent CT-Scan techniques. However, it still has a place in facial trauma because it makes it possible to highlight certain indirect signs and possibly direct signs of orbital floor fractures. Sometimes these are images of unraveling which are taken systematically in the emergency room and therefore supplemented later by more appropriate explorations, as CT-Scan in particular.

Treatment of orbital floor fractures is aimed at relieving the injured person, reconstructing the orbital floor, treating associated lesions and avoiding complications. It combines medical treatment systematically and surgical treatment as needed.

Medical treatment includes the use of analgesics, steroidal or non-steroidal anti-inflammatory drugs, and broad-spectrum antibiotics. The systematic use of antibiotics in our treatment is consistent with the work of Shuttleworth et al. [20] who recommended that all patients with orbital trauma should receive prophylactic antibiotics to prevent the risk of possible orbital cellulitis. In our context, this attitude was justified especially since there were associated skin lesions. In addition, the health care conditions are precarious in our context; then an infection could occur secondarily, complicating the initial lesions.

Surgical treatment ensures reconstruction of the orbital floor as close as possible to its initial anatomy, frees the incarcerated soft tissues, and if necessary manages eye and eyelid lesions and other associated lesions. In our study 86.27% of patients received surgical treatment; abstention from treatment being justified whenever the orbital floor fracture was not accompanied by morphological and functional signs, and whenever the CT-Scan signs were minimal as recommended by Roth et al. [21]. For some authors, this surgery must be early in the first hours following the trauma [22] in order to facilitate the surgical procedure and limit the functional sequelae. For others, this surgical management is justified after the edema has gone away, as this can be achieved in 3 to 7 days with an anti-edema drug [6] [23]. In our study, these functional sequelae were objectified in 13.65% of patients and are linked to the delay before surgical management (18 days on average). These delays before treatment can be explained by the financial difficulties of patients and the lack of specialized centers for the treatment of these lesions in our health care centers. In well-equipped countries, treatment times are short [17] [22] [23] with better results.