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Orbital fractures in children
1Section of Pediatric Otolaryngology, Medical College, Albany, NY, USA.
Insights
Orbital roof fractures occur in younger children due to their larger cranium, while lower orbital fractures affect older children as facial structures develop. Age significantly influences fracture patterns and associated injuries.
Area of Science:
- Pediatric Traumatology
- Craniofacial Development
- Ophthalmology
Background:
- The orbit's unique position at the craniofacial junction makes it susceptible to fractures influenced by growth.
- Childhood craniofacial development involves significant changes in the ratio of the cranium to the face.
- Understanding age-related fracture patterns is crucial for appropriate diagnosis and management.
Purpose of the Study:
- To investigate the relationship between a child's age and the pattern of orbital fractures.
- To determine if craniofacial growth influences the likelihood of specific orbital fracture types.
- To identify age thresholds for different orbital fracture patterns.
Main Methods:
- Retrospective case series of 40 pediatric patients (1-16 years) with orbital fractures.
- Data collected included age, fracture site, mechanism of injury, and associated injuries.
- Statistical analysis, including logistic regression, was used to analyze age-related patterns.
Main Results:
- Orbital roof fractures were more common in younger children (mean age 4.8 years) compared to other orbital fractures (mean age 12.0 years).
- The probability of lower orbital fractures exceeding orbital roof fractures occurred around 7.1 years of age.
- Orbital roof fractures were associated with higher rates of neurocranial injuries and required less surgical intervention.
Conclusions:
- Orbital roof fractures are primarily seen in younger children, linked to a proportionally larger cranium and undeveloped frontal sinuses.
- Lower orbital fractures are more prevalent in older children, correlating with facial growth and paranasal sinus pneumatization.
- Age is a critical factor in determining the type and management of pediatric orbital fractures.
Objective:
To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium.
Design:
Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures.
Setting:
The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center.
Outcome Measures:
The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992.
Results:
Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8 +/- 3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0 +/- 4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1 +/- 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger.
Conclusions:
Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses.