Differences in Common Orbital Blowout Fracture Sites by Age

Takahashi, Yasuhiro; Nakakura, Shunsuke; Sabundayo, Maria Suzanne; Kitaguchi, Yoshiyuki; Miyazaki, Hidetaka; Mito, Hidenori; Kakizaki, Hirohiko

doi:10.1097/prs.0000000000004397

Cited by 23 publications

(41 citation statements)

References 33 publications

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“…Previous reports hypothesized that the patients with a fewer ethmoid air cell septa and a larger lamina papyracea area per septum are more likely to develop isolated medial wall fractures than inferior wall fractures when similar extrinsic forces acted on the periocular region [15,16]. However, Kang et al showed that the development of spontaneous medial orbital wall decompression was not associated with the structure of ethmoid bone or sinus [1].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors

Vaidya

Lee

Kitaguchi

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate spontaneous decompression of the medial orbital wall and orbital floor in thyroid eye disease using new measurement methods and to analyze the influential factors. Methods This retrospective study included 86 patients (172 sides). Regarding evaluation of spontaneous medial orbital decompression, an anteroposterior line was drawn between the posterior lacrimal crest and the junction between the ethmoid bone and corpus ossis sphenoidalis. The bulged and/or dented areas from that line were measured. Regarding evaluation of spontaneous orbital floor decompression, the length of the perpendicular distance from a line that was drawn between the inferior orbital rim and the orbital process of palatal bone to the tip of the superior bulge of the orbital floor was measured. Results Multivariate linear regression analysis revealed that the maximum cross-sectional areas of the superior rectus/levator palpebrae superioris complex (P = 0.020) and medial rectus muscle (P = 0.028) were influential factors for spontaneous decompression of medial orbital wall (adjusted r 2 = 0.090; P < 0.001), whereas the number of cycles of steroid pulse therapy (P = 0.002) and the maximum cross-sectional area of the inferior rectus muscle (P = 0.007) were the ones for that of the orbital floor (adjusted r 2 = 0.096; P < 0.001). Conclusion We believe that the identification of multiple influential factors of spontaneous decompression of the medial orbital wall and orbital floor will be helpful for better understanding and planned management of thyroid eye disease patients undergoing orbital decompression surgery.

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Section: Discussionmentioning

confidence: 99%

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors

Vaidya

Lee

Kitaguchi

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…The demographic data analysis indicated similar findings as those of previous studies [1,2]; orbital fractures were more common in male children, 56.1% were linear-or trapdoor-type fractures, with a 27.9% rate of surgical repair. However, based on the fact that the most common mechanisms of trauma in this study were assault, slip, and sports injury, in contrast to traffic accident and sports injury in previous studies [12], it can be presumed that the factors resulting in trauma were limited to those of weaker strength due to the exclusion of fractures other than pure orbital fractures in this study.…”

Section: -Specificitymentioning

confidence: 81%

Surgical indication analysis according to bony defect size in pediatric orbital wall fractures

Kim

Choi

Hwang

et al. 2020

Arch Craniofac Surg

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Background: Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods: We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results: A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01 ± 2.99 years. The defect size (p = 0.002) and fracture type (p = 0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p < 0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p = 0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 cm 2 was obtained (sensitivity, 0.543; specificity, 0.724; p = 0.002). Conclusion: The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 cm 2 may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.

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“…The orbital medial wall is prone to fracture due to this buckling force compared with the orbital floor because it is much thinner 4,8,10 . Additionally, as orbital contents decrease with age, older patients are at a greater risk of experiencing impact on the orbital rim instead of the globe 11,19 …”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies have demonstrated differences in orbital fracture sites among age groups 9–11 . Choi et al 9 showed that patients younger than 18 years had a larger proportion of orbital floor fractures compared with those older than 18 years.…”

mentioning

confidence: 99%

Comparison of Blowout Fracture Sites Observed in Young and Elderly East Asians

Hong

Choi

Kim

et al. 2021

Journal of Craniofacial Surgery

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Differences in Common Orbital Blowout Fracture Sites by Age

Abstract: Common orbital blowout fracture sites varied among age groups. These differences may be attributed to multiple factors, including differences in the morphology of the orbit and paranasal sinuses, composition of the facial bone, and causes of injury among age groups.

Cited by 23 publications

References 33 publications

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors

Surgical indication analysis according to bony defect size in pediatric orbital wall fractures

Comparison of Blowout Fracture Sites Observed in Young and Elderly East Asians

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