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Updated: Jul 5, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric
Keshini C Parbhu1, KoriAnne E Galler, Chun Li
1Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA.
Insights
Pediatric orbital floor fractures require earlier surgical repair than adult fractures, often due to entrapment. Radiologic imaging can underestimate entrapment in children, highlighting the need for clinical evaluation.
Area of Science:
- Ophthalmology
- Trauma Surgery
- Pediatric Surgery
Background:
- Orbital floor fractures are common injuries requiring surgical intervention.
- Management strategies and outcomes can differ between pediatric and adult patients.
Purpose of the Study:
- To compare the timing, radiologic, and clinical indications for surgical management of orbital floor fractures.
- To evaluate concordance between imaging and intraoperative findings in pediatric versus adult populations.
Main Methods:
- Retrospective observational case series of 24 pediatric and 31 adult patients undergoing primary orbital floor fracture repair.
- Analysis of surgical timing, clinical indications, radiologic evidence (CT), and intraoperative findings over an 8-year period.
Main Results:
- Pediatric fractures were repaired significantly earlier (average 3 weeks) than adult fractures.
- Entrapment was the primary surgical indication in pediatric patients, while enophthalmia predominated in adults.
- Computed tomography (CT) underestimated entrapment in pediatric cases, showing poor concordance with clinical and intraoperative findings, unlike in adults.
Conclusions:
- Pediatric orbital floor fractures, often trapdoor type, necessitate earlier surgical intervention.
- Radiologists may miss orbital soft tissue entrapment on CT in pediatric patients.
- Clinical assessment is crucial due to potential discrepancies between imaging and surgical findings in pediatric orbital fractures.
Purpose:
To compare the timing, radiologic, and clinical indications for surgical management of orbital floor fractures in the pediatric and adult populations.
Design:
Retrospective observational case series.
Participants:
Twenty-four pediatric and 31 adult patients who underwent primary repair of an orbital floor fracture.
Methods:
The records of all patients presenting to the oculoplastics service for primary repair of orbital floor fracture over an 8-year period were reviewed.
Main Outcome Measures:
Time to surgical intervention, clinical indication for surgery, radiologic evidence, and intraoperative findings of entrapment.
Results:
Pediatric orbital floor fractures were repaired an average of 3 weeks earlier than adult fractures. The most common clinical indication for surgery was entrapment in the pediatric group versus enophthalmia in the adult group. There was a significant underestimation of entrapment reported on computed tomography (CT) in the pediatric group when compared with the clinical indications and intraoperative findings. Conversely, there was good concordance between radiologic and intraoperative findings in the adult group.
Conclusions:
Pediatric orbital floor fractures are often of the trapdoor type, which require earlier surgical intervention. Entrapment and incarceration of orbital soft tissue contents as imaged by CT can be missed by radiologists. Our study demonstrates the poor concordance between radiologic and intraoperative evidence for entrapment in the pediatric population. It is important for the clinician to review all radiologic studies and to perform a thorough ophthalmologic evaluation to aid with clinical decision making.
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