LAUSR

To the Editor: W e read with the interest Ng et al's recently published article regarding the routine use of computed topography after orbit fracture repair. The article begins to fill a gap where little data that clearly support or refute the need for postoperative imaging are available. From a cost perspective, the authors conclude that imaging is overrated and that physical examination alone is a better predictor for revision surgery. It is an interesting question to ask whether imaging of fracture reduction is required after open surgery. Can a surgeon accurately determine bony reduction quality without x-ray validation? If intraoperative and postoperative scans are the standard of care in orthopedic trauma surgery, why does facial fracture or orbit fracture repair require justification? The goals of orbital floor reconstruction are to restore the bony confines of the orbit, reduce the extraocular muscles and periorbital fat, and achieve symmetric globe position in the orbit—all while avoiding iatrogenic injury. A variety of surgical approaches and dissection planes have been described to optimize visualization andminimize error in reduction. Despite innovations by plastic surgeons, facial plastic surgeons, oral surgeons, and oculoplastic surgeons, orbital floor fracture repair remains technically challenging and arouses controversy. Minor and major complication rates can range from 5% to 24%. There are several limitations to Dr Ng's study, which prevent a firm conclusion that postoperative imaging can be frivolous. It is unclear if patient accrual in each limb was random, consecutive, specialty specific, or related to fracture complexity. Although demographic data were collected, the fracture details were not recorded consistently. Amore complex fracture pattern—larger size, comminution, medial wall involvement, absence of the posterior ledge, and concomitant orbital rim fracture— would intuitively invite more need for postoperative imaging and have a higher revision rate. The type of material placed can also affect shortand long-term results. Bone graft source