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Updated: Dec 2, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Surgical indication analysis according to bony defect size in pediatric orbital wall fractures
Seung Hyun Kim1, Jun Ho Choi1, Jae Ha Hwang1
1Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
Insights
Pediatric orbital fractures larger than 1.81 cm2, especially open-door types, increase enophthalmos risk. This finding helps identify extensive fractures needing intervention to prevent cosmetic issues.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Facial Trauma
Background:
- Orbital fractures are common in children, often treated conservatively due to resilience.
- Extensive fractures can rarely cause enophthalmos (sunken eye), leading to cosmetic concerns.
Purpose of the Study:
- To establish criteria for identifying extensive pediatric orbital fractures.
- To determine fracture characteristics associated with enophthalmos in children.
Main Methods:
- Retrospective review of 305 pediatric orbital fracture cases (0-15 years).
- Fracture classification (linear, trapdoor, open-door) and defect size estimation via CT scans.
- Analysis of enophthalmos severity in non-operated patients.
Main Results:
- Defect size and fracture type significantly affected enophthalmos.
- Open-door fractures were associated with larger defect sizes.
- A cutoff defect size of 1.81 cm2 predicted enophthalmos (sensitivity 0.543, specificity 0.724).
Conclusions:
- Enophthalmos incidence in pediatric orbital fractures correlates with fracture size.
- Open-door fractures exacerbate this risk.
- Fractures exceeding 1.81 cm2 should be considered extensive and potentially cosmetic-impacting.
Background:
Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos.
Methods:
We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures.
Results:
A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01± 2.99 years. The defect size (p= 0.002) and fracture type (p= 0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p< 0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p= 0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 cm2 was obtained (sensitivity, 0.543; specificity, 0.724; p= 0.002).
Conclusion:
The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 cm2 may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.
