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Updated: May 9, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Orbital fractures in children: a review of outcomes
Barbara Gerber1, Paul Kiwanuka, Daljit Dhariwal
1Oral & Maxillofacial Surgery Department, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, United Kingdom.
Insights
Prompt surgery is crucial for pediatric orbital floor fractures to minimize complications. Early surgical intervention, especially within one day, significantly reduces risks and improves outcomes in children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Surgery
Background:
- Orbital floor fractures are the third most common facial fractures in children, with unique etiological and clinical presentations compared to adults.
- Medial wall and orbital floor are the most frequently affected sites in pediatric orbital fractures.
- The oculocardiac reflex can be a key indicator of trapdoor orbital fractures, even with minimal clinical signs.
Purpose of the Study:
- To analyze the characteristics, management, and outcomes of orbital floor fractures in pediatric patients.
- To investigate the impact of surgical timing on complication rates in pediatric orbital floor fractures.
Main Methods:
- Retrospective study of 24 pediatric patients (<18 years) with orbital floor fractures between 2005 and 2010.
- Data collected on etiology, clinical presentation, operative timing, surgical procedures, and postoperative outcomes.
- Analysis of fracture types, including trapdoor and open blow-out fractures, and associated symptoms.
Main Results:
- Most injuries (mean age 13.5 years) resulted from falls, with isolated orbital floor fractures in 58% of cases.
- Trapdoor fractures (46%) and open blow-out fractures (38%) were common; nausea and vomiting occurred in 54% of patients.
- Early surgery (within 1 day) was associated with fewer complications compared to delayed surgery (after 3 days).
Conclusions:
- Prompt surgical intervention is essential for all pediatric orbital floor fractures to prevent compromised outcomes.
- Postoperative complications like diplopia and restricted eye movement were linked to trapdoor injuries.
- Enophthalmos and paresthesia were associated with open blow-out fractures, highlighting the need for timely management.
Abstract:
The third most common facial fractures in children are fractures of the orbit, and the medial wall and floor are the commonest sites affected. The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005-2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia (n=6/11) and restricted eye movement (n=3/11) were associated with trapdoor injury, while enophthalmos (n=1/9) and paraesthesia (n=3/9) were related to open blow-out fractures. To reduce compromised outcomes, prompt operation is warranted in all children with fractures of the orbital floor regardless of the configuration.
