Indications for Emergency Surgery in Pediatric Orbital Floor Fractures: Orbital Content Entrapment and Computed...

In pediatric orbital fractures, it is often difficult to ascertain whether muscle or orbital fat is truly entrapped or is merely flanked by bony fragments. This study was conducted to compare intraoperative findings with preoperative computed tomographic impressions in instances of confirmed orbital content entrapment.

A retrospective chart review was undertaken, limited to pediatric patients suffering orbital fractures between February 2002 and January 2023. Subjects were assigned to 1 of 2 groups (entrapment or non-entrapment), reflecting the presence or absence of orbital content incarceration. Preoperative computed tomographic scans were reviewed in all instances for between-group comparison of orbital floor bone gaps in coronal views.

Fourteen patients qualified as entrapment, as opposed to 8 categorized as non-entrapment. Group demographics were similar in terms of age and sex. Orbital floor bone gaps ranged from 1 to 3 mm in patients with entrapment, whereas members of the non-entrapment subset displayed gaps >4 mm. Postoperative diplopia fully resolved within 12 months, except in one patient with entrapment (3 mm bone gap) and a missing rectus on imaging who remained slightly diplopic in downward gaze.

Orbital floor bone gap <3 mm may well constitute a new indication for emergency surgical treatment of pediatric orbital fractures, even in minimally symptomatic states (no oculocardiac reflex or moderate diplopia), to ensure the integrity of inferior rectus muscle and its fibrous connections.