Adult Orbital Trapdoor Fracture

Kum, Clarissa; McCulley, Timothy J.; Yoon, Michael K.; Hwang, Thomas N.

doi:10.1097/iop.0b013e3181b80e95

Cited by 18 publications

(8 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the variations in diagnostic definitions used for OTFs, when critically reviewing the current literature, there are a few of cases/case series of pure OTFs that have been reported in adult patients (Table 1). 912151617181920 The age of oldest patient suffered from an OTF was 53 years 9. Also, isolated cases of adult patients encountered in retrospective studies whose almost all of their patients are children.…”

Section: Discussionmentioning

confidence: 99%

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Papadiochos

Petsinis

Tasoulas³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Papadiochos

Petsinis

Tasoulas³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

show abstract

“…5 A 2009 case report described a 37-year-old man with blunt trauma resulting in only diplopia and dysmotility with no obvious fracture or prolapsed muscle on CT, which resolved after orbital exploration and release of entrapped muscle sheath and adventitia. 6 In the same issue, a case report described a 40-year-old man with blunt trauma resulting in a very large orbital floor fracture who demonstrated only pain, intermittent nausea and bradycardia, which also promptly resolved after surgical repair of the fracture. 7 Our case represents a minimally displaced floor fracture resulting in a reproducible oculocardiac reflex.…”

Section: Discussionmentioning

confidence: 95%

The Oculocardiac Reflex in an Adult with a Non-Displaced Orbital Floor Fracture

Kasi

Gorovoy

Vagefi

et al. 2014

Orbit

View full text Add to dashboard Cite

The current dogma is that the oculocardiac reflex from orbital trapdoor fractures occurs only in children and young adults. We present the occurrence of the oculocardiac reflex in an adult with a non-displaced orbital floor fracture. CT demonstrated the adventitia surrounding the inferior rectus trapped in and below the orbital floor fracture. The patient's oculocardiac reflex resolved by early next morning, presumably from the tissue escaping from the orbital floor defect.

show abstract

“…6). This fracture pattern was first described in 1965 by Soll and Poley, who coined the term “trapdoor fracture.”4 Although a case of inferior rectus muscle sheath entrapment in an adult patient occurring in a nondisplaced fracture has been reported,5 review of the literature suggests that extraocular muscle entrapment is extremely rare in the adult subgroups 26. Similarly, a case of medial rectus entrapment in a nondisplaced medial wall fracture has been reported,7 but review of all reported cases of medial rectus entrapment appears to be near exclusive to children 8…”

Section: Discussionmentioning

confidence: 99%

Orbital Floor Fracture with Atypical Extraocular Muscle Entrapment Pattern and Intraoperative Asystole in an Adult

Merali

Grant

Mahoney

2015

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

).Extraocular muscle entrapment in the setting of orbital floor fractures, when precisely defined as muscle incarcerated in a nondisplaced fracture line, is rarely seen in adults. This is in contrast to herniation of extraocular muscles through a fracture defect, which is common. The oculocardiac reflex (OCR) is a sign that can be elicited in patients with entrapped muscle tissue and is typically defined as the triad of bradycardia, nausea, and syncope. We present an interesting case of muscle entrapment in a partially nondisplaced two-wall orbital fracture with accompanying preoperative bradycardia and intraoperative asystole in an adult. Case ReportA 27-year-old man was struck with a fist in the left periorbital area, and onset of binocular vertical diplopia and left orbital pain with eye movements was immediately noted. He was otherwise asymptomatic. Past medical history was notable only for asthma.On examination, best corrected visual acuity and intraocular pressures were within normal limits. There was no relative afferent pupillary defect. Extraocular movement of the right eye was normal, but demonstrated an 80% reduction of upgaze of the left eye (►Fig. 1). There was an elicited OCR with the patient's heart rate consistently dropping 33%, from 75 to 50 beats per minute during attempted upgaze with associated nausea and presyncopal symptoms. Horizontal motility was normal. There was 2 mm of enophthalmos of the left globe. Anterior and posterior segment exams of both eyes were within normal limits; no associated injuries were identified on the ED screening examination Noncontrast orbital CT scan demonstrated a comminuted left orbital floor fracture and an associated minimally displaced fracture of the left lamina papyracea and nasal bones. The shape of the inferior rectus muscle was distorted vertically and it appeared to be partially entrapped in the orbital floor fracture (►Fig. 2).Surgical exploration and fracture repair were conducted as soon as possible and within 24 hours of presentation. Forced duction testing performed intraoperatively confirmed restrictive strabismus. Upon exploration, the orbital floor fracture was identified and entrapped inferior rectus muscle tissue at the orbital floor fracture site identified. During release of the anterior portion of entrapped inferior rectus muscle, gentle Keywords ► orbital fracture ► extraocular muscle entrapment ► adult trapdoor fracture AbstractExtraocular muscle entrapment in a nondisplaced orbital fracture, although a wellknown entity in pediatric trauma, is atypical in adults. It can present with a triad of bradycardia, nausea, and in rare cases, syncope, and result in severe fibrosis of damaged and incarcerated muscle. We present a case of muscle entrapment in a partially nondisplaced two-wall orbital fracture with accompanying preoperative bradycardia and intraoperative asystole in an adult

show abstract

Adult Orbital Trapdoor Fracture

Cited by 18 publications

References 5 publications

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

The Oculocardiac Reflex in an Adult with a Non-Displaced Orbital Floor Fracture

Orbital Floor Fracture with Atypical Extraocular Muscle Entrapment Pattern and Intraoperative Asystole in an Adult

Contact Info

Product

Resources

About