Characteristics and surgical management of pure trapdoor fracture of the orbital floor in adults: a 15-year review

Abstract

Purpose This retrospective study aims to define the optimal timing of the surgical treatment of orbital floor trapdoor fractures (OFTFs) in adults according to clinical and radiological findings. Methods From January 2006 to December 2020, 382 patients with isolated orbital floor fracture were admitted to the Division of Maxillofacial Surgery of Turin, Italy. The criteria for inclusion were age ≥ 16 years, preoperative computed tomography showing a linear (1a) or medial hinge fracture (1b), diplopia, and 6 months of follow-up data. Aetiology and mechanism of injury, presence of post-traumatic enophthalmos and oculocardiac reflex, time between trauma occurrence and surgery [stratified as < 24 h (urgent treatment), 24–96 h (early treatment), and > 96 h (late treatment)], days of hospitalisation, and clinical outcomes were examinated. Results Twenty-four patients (18 males; mean age, 23.2 years) presented with OFTFs. The most common cause was sport injury (50%). Type 1a fracture was observed in eight patients (mean age, 19.5 years), type 1b fracture in 16 patients (mean age, 23.6 years). Urgent, early, and late treatments were performed in eight patients each. The mean time between trauma occurrence and surgery was 3,8 days (range: 0–17 days). Resolution of diplopia was observed 1 week after surgery in 10 patients, 1 month in 12. Diplopia persisted in 2 patient, both treated > 96 h after trauma. Conclusion Although the number of patients was too small to define a standard protocol, the authors recommend early treatment of adult OFTFs to promote complete resolution of diplopia.

Correlation between Tomography Scan Findings and Clinical Presentation and Treatment Outcomes in Patients with Orbital Floor Fractures

“…However, the highlight of this study is the complete absence of any significant results regarding the displacement of the rectus inferior muscle or the formation of a "trap door" by broken bony fragments. This finding is in stark contrast to the popular belief, widely assumed, that ocular mobility in patients with orbital fractures becomes impaired because of the displacement and entrapment of the rectus inferior muscle [3,19,20]. Notably, however, these beliefs, though widely held, are grounded more in common sense and anecdotal observation than on a foundation of empirical evidence derived from substantial research, as we have not found any comprehensive research paper that could prove them.…”

Orbital Trapdoor Fracture With Extraocular Muscle Entrapment in Adults: A Case Series

“…23 However, these previous reports did not disclose the presence of extraocular muscle entrapment in adult patients. 15,16,[18][19][20][21][22][23] We found 11 previously reported cases of orbital trapdoor fracture with extraocular muscle entrapment (Table 2). [4][5][6][7][8][9][10][11][12][13] The mean age of our patients combined with the previously reported patients (16 patients) was 26.1 years.…”

“…14 With regards to orbital trapdoor fracture, several previous studies have established the demographic profile and rarity of adult cases. 15,16,[18][19][20][21][22][23] Chi et al 15 examined 733 patients with orbital fracture and showed 1 adult patient (0.2%) with trapdoor fracture, while 57 other cases of orbital trapdoor fracture occurred in pediatric patients (39.6%). Parbhu et al 16 reported that 2 out of 55 adult patients had orbital trapdoor fracture.…”

“…Kwon et al 18 presented 24 out of 54 adult patients (44%) with orbital trapdoor fracture. Gugliotta et al 19 reviewed 24 adult patients of orbital trapdoor fracture in their 15-year experience. Chen et al 20 analyzed influential factors of surgical outcomes in 72 patients with orbital trapdoor fracture.…”

“…23 However, these previous reports did not disclose the presence of extraocular muscle entrapment in adult patients. 15,16,18–23…”