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Updated: Jun 1, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Pediatric orbital floor fractures
Leslie A Wei1, Vikram D Durairaj
1Department of Ophthalmology, University of Colorado, School of Medicine, Denver Colorado, USA.
Insights
Pediatric orbital floor fractures often present as trapdoor fractures with soft tissue incarceration, causing restricted eye movement. Early surgical repair within 48 hours improves outcomes for children with these injuries.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Surgery
Background:
- Orbital floor fractures in children have unique clinical presentations and management considerations.
- Understanding these differences is crucial for optimal patient outcomes.
Purpose of the Study:
- To summarize the unique aspects of pediatric orbital floor fractures regarding clinical presentation, management, and outcomes.
- To provide insights into the effective treatment of these injuries in young patients.
Main Methods:
- A comprehensive literature search was conducted using PubMed for English-language articles on pediatric orbital floor fractures.
- 25 relevant studies were included after excluding complex fractures, case reports, and studies not analyzing pediatric patients separately.
Main Results:
- Inferior trapdoor fractures with soft tissue incarceration are most common (27.8%-93%), often presenting with restricted extraocular motility and diplopia (44%-100%).
- Minimal external trauma signs are typical, alongside symptoms like nausea and vomiting (14.7-55.6%).
- Early surgical repair (within 2-5 days) is associated with faster recovery and better postoperative motility.
Conclusions:
- Prompt surgical intervention within 48 hours of diagnosis is recommended for pediatric orbital floor fractures with symptomatic diplopia and confirmed soft tissue entrapment.
- Early surgical repair leads to improved postoperative outcomes.
- Further long-term prospective studies are needed to fully characterize these fractures in children.
Purpose:
To summarize the unique aspects of orbital floor fractures in children with regard to clinical presentation, management, and outcomes.
Methods:
MEDLINE was searched using PubMed for English-language articles on orbital floor fractures in children. All 154 indexed articles pertaining to floor fractures in patients under 18 years of age in PubMed were reviewed. Studies looking at primarily complex fractures and case reports and studies that included pediatric patients but did not analyze them separately were excluded. Overall, 25 studies were included for the review.
Results:
Inferior trapdoor fractures with muscle and soft tissue incarceration are the most common type of orbital fracture in children (27.8%-93%). They often present uniquely with severely restricted extraocular motility and diplopia (44%-100%), nausea and vomiting (14.7-55.6%), and minimal signs of external trauma. The majority of studies (83%) that analyzed time to surgery in relation to outcomes found that children who present early after initial injury and undergo prompt surgical repair appear to recover faster and have better postoperative motility than those receiving delayed treatment.
Conclusions:
Our understanding of pediatric orbital floor fractures continues to evolve. For young patients with symptomatic diplopia with positive forced ductions, soft tissue entrapment confirmed by computed axial tomography, and/or trapdoor fracture plus restricted ocular movement, having surgery within 2-5 days has been shown to result in better postoperative outcomes. It is recommended that surgery be considered within 48 hours of diagnosis. Long-term prospective studies are still needed to further characterize orbital floor fractures in children.
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