Multidisciplinary Treatment of a Pediatric Orbital Roof Fracture: Case Report and Literature Review

Pediatric orbital roof fractures are a relatively rare trauma. In children, fractures of the facial skeleton can be associated with significant morbidity. Potential complications of orbital roof fracture include both neurosurgical complications such as frontal lobe injury, dural tears, or herniation, and ophthalmologic and reconstructive surgery problems such as proptosis, diplopia, and extraocular muscle entrapment. In most cases, surgical intervention is unnecessary, as these fractures are minimally displaced. When surgery is warranted, however, for displaced fractures or those associated with complications, a multidisciplinary approach is often indicated. Here, we report a case of a 10-year-old boy with a superiorly displaced orbital roof fracture resulting from a bicycle brake handle injury. The primary fragment was intracranially displaced and embedded in the inferior frontal lobe, causing frontal lobe herniation and left globe proptosis. A transcranial approach was performed using an autologous bone graft. In our case, a multidisciplinary surgical approach facilitated repair of both the dural and orbital injuries and multi-layer separation of the 2 spaces.