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Internal orbital fractures in the pediatric age group: characterization and management
1Lions Eye Institute, Department of Ophthalmology, Albany Medical College, New York 12208, USA.
Insights
Pediatric internal orbital fractures, often trapdoor-type, require prompt surgical intervention for optimal ocular motility recovery. Early treatment (<2 weeks) improves outcomes in children with these orbital floor fractures.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Surgery
Background:
- Internal orbital fractures, commonly known as blowout fractures, present unique challenges in pediatric patients.
- Understanding the specific characteristics and management strategies is crucial for optimal patient outcomes.
Observation:
- A retrospective observational study reviewed 34 pediatric patients (ages 1-18) with internal orbital fractures over five years.
- Fracture patterns, surgical interventions, and clinical outcomes including ocular motility, enophthalmos, and associated symptoms were analyzed.
Findings:
- Orbital floor fractures constituted the majority (71%) of cases.
- Eleven patients required surgery for ocular motility restriction, with eight cases identified as trapdoor-type fractures involving soft-tissue incarceration.
- Early surgical intervention (less than two weeks) correlated with a more complete return of ocular motility compared to delayed treatment.
Implications:
- Trapdoor-type orbital floor fractures in children can be subtle on imaging, necessitating clinical suspicion.
- Significant motility restriction and symptoms like nausea/vomiting warrant prompt surgical evaluation and intervention.
- Timely surgical management is key to restoring function and preventing long-term complications in pediatric orbital fractures.
Objective:
To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population.
Design:
Retrospective observational case series.
Participants:
Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures.
Methods:
Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management.
Main Outcome Measures:
Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications.
Results:
Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group.
Conclusions:
Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.