Pediatric growing orbital roof fracture with ptosis: a case report

Valencia H X Foo1, Shirley P Ma2, Sunny Shen1

  • 1Department of Oculoplastic Surgery, Singapore National Eye Centre, Singapore, Singapore.

PubMed

Insights

Pediatric orbital roof fractures, even minor ones, can rarely progress to growing skull fractures. This case shows a child developing an orbital meningoencephalocele and ptosis months after initial trauma.

Area of Science:

  • Pediatric Traumatology
  • Neurosurgery
  • Ophthalmology

Background:

  • Most pediatric skull fractures are minimally displaced and managed conservatively.
  • Growing skull fractures (GSF) are rare but serious complications, potentially causing significant sequelae.
  • Orbital roof fractures, even minor ones, require careful monitoring due to potential for delayed complications.

Purpose of the Study:

  • To report a case of a pediatric orbital roof fracture progressing to a growing skull fracture with orbital meningoencephalocele.
  • To emphasize the importance of vigilant follow-up for seemingly minor pediatric orbital fractures.

Main Methods:

  • Case report of a 6-year-old boy with initial right orbital roof "blow-up" fracture and traumatic ptosis.
  • Clinical observation detailing the progression of the fracture and development of complications over seven months.
  • Review of literature on growing skull fractures and orbital meningoencephaloceles in pediatric head trauma.

Main Results:

  • Initial minimally displaced orbital roof fracture progressed to a growing orbital roof fracture.
  • Development of an orbital meningoencephalocele and persistent ptosis occurred seven months post-injury.
  • The case illustrates a rare but severe complication following minor head trauma.

Conclusions:

  • Early multidisciplinary evaluation and long-term follow-up are crucial for pediatric orbital roof fractures.
  • Clinicians must be aware of the potential for delayed complications like growing skull fractures and orbital meningoencephaloceles.
  • Vigilance is necessary even when initial pediatric head trauma appears minor.

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