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Pediatric orbital floor fractures: nausea/vomiting as signs of entrapment

Seth M Cohen1, C Gaelyn Garrett

  • 1Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA. seth.cohen@vanderbilt.edu

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|July 19, 2003
PubMed

Insights

Nausea and vomiting in children with trapdoor orbital fractures indicate a high risk of inferior rectus muscle entrapment. Early recognition is crucial for better outcomes in pediatric orbital fractures.

Area of Science:

  • Ophthalmology
  • Pediatric Surgery
  • Trauma Surgery

Background:

  • Orbital floor fractures are common in pediatric trauma.
  • Inferior rectus muscle entrapment can lead to significant morbidity.

Purpose of the Study:

  • To determine if nausea and vomiting predict entrapment in pediatric orbital floor fractures.
  • To assess the association between trapdoor fractures and inferior rectus entrapment.

Main Methods:

  • Retrospective analysis of pediatric orbital floor fractures (1990-2001).
  • Exclusion of zygomatic, naso-orbital ethmoid, and displaced orbital rim fractures.
  • Data collection on fracture type, symptoms, ocular motility, and surgical outcomes.

Main Results:

  • 29 orbital floor fractures identified; 25% experienced nausea/vomiting.
  • 50% had trapdoor fractures, and 17% had inferior rectus entrapment.
  • Nausea/vomiting with trapdoor fractures had an 83.3% positive predictive value for entrapment (P=0.002).

Conclusions:

  • Children with trapdoor orbital fractures and nausea/vomiting face a high risk of inferior rectus entrapment.
  • Prompt surgical intervention is often required for diplopia or gaze restriction.
  • Some patients experience persistent gaze impairment despite treatment.
Abstract

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