Supraorbital roof fractures: a formidable entity with which to contend

Supraorbital roof fractures are uncommon. The incidence has been quoted at between 1 and 5%. We believed that the incidence and morbidity of supraorbital roof fractures were actually higher. The charts of 621 inpatients with facial fractures between September 1993 and September 1995 were retrospectively reviewed. Parameters included patient characteristics; mechanism of injury; fracture characteristics; associated clinical, computed tomography, and operative findings; presence of associated skull and frontal sinus fractures; and complication rates. Fifty-eight patients (9.3%) had supraorbital roof fractures, making this one of the largest series. The average age was 31 years and the predominant mechanism of injury was motor vehicle accidents. Sixty-nine percent of the patients had associated skull fractures and 54% had frontal sinus fractures. Thirty-one of the cases were open and 32 cases were treated operatively. Dural tears were present in 14 patients, traumatic encephalocele in 3, proptosis in 6, pulsatile proptosis in 3, orbital apex syndrome in 1, persistent cerebrospinal fluid leak in 3, and meningitis in 5. A majority of the patients had associated intracranial bleeds. The incidence and morbidity of supraorbital roof fractures are much higher than previously thought. The treatment of cases should be individualized, taking into account displacement, association with skull and frontal sinus fractures, dural tears, and intracranial hemorrhage.