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Traumatic Orbital Roof Fracture With Superior Rectus Entrapment in a Pediatric Patient
Siri P Yalamanchili1, Zena A Ibrahim1, Edward J Wladis1,2
1Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany, New York, U.S.A.
Insights
A pediatric orbital roof fracture caused superior rectus muscle entrapment, requiring surgical release. This case highlights the importance of evaluating extraocular muscle function in pediatric orbital trauma.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Craniofacial Surgery
Background:
- Orbital fractures are common in pediatric facial trauma, frequently involving the orbital floor.
- Extraocular muscle entrapment necessitates prompt surgical intervention to prevent vision-threatening complications.
- Accurate diagnosis and management are critical for preserving ocular function in pediatric patients.
Observation:
- A 2-year-old male presented with multiple left orbital wall fractures, including the orbital roof, after a fall.
- The patient exhibited limited upward gaze in the left eye (OS).
- Positive forced ductions indicated potential entrapment of the superior rectus muscle.
Findings:
- Surgical exploration revealed entrapment of the superior rectus muscle within the orbital roof fracture.
- The entrapped muscle was successfully freed.
- The patient experienced a full recovery with complete restoration of extraocular movements.
Implications:
- This case is the first reported instance of superior rectus muscle entrapment associated with an orbital roof fracture in a pediatric patient.
- It underscores the need for thorough ophthalmological evaluation in pediatric orbital trauma, even with atypical fracture patterns.
- Early surgical management of muscle entrapment is vital for optimal functional outcomes in pediatric orbital fractures.
Abstract:
Pediatric patients often present with orbital fractures after facial trauma, most commonly fractures of the orbital floor. Evaluation of orbital fractures for entrapment of the extraocular muscles is crucial, as urgent surgical exploration and possible repair are needed in these cases. We report a 2-year-old male who presented after a fall with multiple left orbital wall fractures, including a roof fracture. On examination, the patient's OS appeared fixed in an upward gaze. Positive forced ductions revealed clinical concern for entrapment of the superior rectus. The patient was taken to the operating room for exploration, and the entrapped superior rectus muscle was freed from the fracture. The patient subsequently recovered fully with complete extraocular movements. This represents the first reported case of superior rectus entrapment in an orbital roof fracture.
