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Updated: Dec 6, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Growing skull fractures of the orbital roof: a multicentric experience with 28 patients
Ibrahim Mohamed Zeitoun1, Kamal Ebeid2, Ahmed Y Soliman3
1Faculty of Dentistry, Alexandria University, 18 Koliat el tib st., Ramlah station, Alexandria, 21526, Egypt.
Insights
Growing skull fractures (GSF) in children require prompt diagnosis and treatment. Surgical repair, including duraplasty and cranioplasty for larger defects, leads to excellent outcomes and high parental satisfaction.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Trauma Surgery
Background:
- Growing skull fracture (GSF) is a rare complication of pediatric head trauma.
- Patients may experience delayed neurological symptoms.
Purpose of the Study:
- To analyze presentations, evaluation, treatment, and outcomes of orbital roof GSF in children.
- To provide insights into managing this specific pediatric condition.
Main Methods:
- Retrospective multicentric cohort study of pediatric patients with orbital roof GSF (2011-2020).
- Data collected included demographics, trauma details, clinical signs, imaging, surgical procedures, and outcomes.
- Review of hospital records from Craniomaxillofacial Plastic Surgery, Neurosurgery, and Otorhinolaryngology departments.
Main Results:
- Twenty-eight pediatric patients with orbital roof GSF were identified; 82.1% were boys, mean age 5 years.
- Common manifestations included eyelid swelling (75%), pulsatile proptosis (25%), headache, and seizures.
- Duraplasty was performed in all cases; cranioplasty was used for defects >25mm. Parental satisfaction was high (95%).
Conclusions:
- Orbital roof GSF must be considered in pediatric head trauma with ocular/neurological signs.
- Duraplasty is essential; cranioplasty is indicated for large defects (>25mm).
- Surgical outcomes are generally favorable, with good subjective and objective results.
Background:
Growing skull fracture (GSF) is a rare condition that may complicate pediatric head trauma. Patients may present with delayed-onset neurological manifestations.
Aim:
This study aims to highlight the different presentations, methods of evaluation, treatment modalities, and outcomes in patients with orbital roof GSF.
Methods:
This retrospective multicentric cohort study reviewed the hospital records of children with GSF who presented at the Craniomaxillofacial Plastic Surgery Department, and Neurosurgery Department with Otorhinolaryngology Department (Maxillofacial unit), from 2011 to 2020. The collected data included age, gender, delay, manifestations, findings of imaging techniques, surgical treatment, complications, and satisfaction of patients' parents.
Results:
Twenty-eight patients with orbital roof GSF were included in this study. Most of the patients (82.1%) were boys, and the mean (SD) age was 5 (2) years old. Head trauma was caused by falls in all cases. Clinical manifestations included eyelid swelling (75%), pulsatile proptosis (25%), headache (17.9%), and seizures (10.7%). The mean (SD) diameter of bony defects was 24.3 (8.7) mm. Duraplasty alone was performed in 57.1%, while dura-cranioplasty was done in 42.9% of patients. Dural reconstruction was done using pericranial graft in 82.1% and artificial grafts in 17.9% of patients. Most of the parents (95%) were absolutely satisfied. No mortalities or recurrence of symptoms were recorded. The median follow-up period after surgery was 3.9 years.
Conclusion:
Orbital roof GSF should be considered among the differential diagnoses in pediatric patients with history of head trauma presenting with ocular and/or neurological manifestations. Duraplasty is mandatory in all cases, whereas cranioplasty is required mainly in cases with large bony defects more than 25 mm. Prognosis in most patients was good both subjectively and objectively.
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