Growing Fractures of the Orbital Roof

Abstract

Growing fractures rarely arise in the skull base. Only six cases of orbital roof growing fractures were found in the relevant literature. We report two such cases. The first case was a 2-year-old girl who had progressive proptosis for 6 months following a mild head injury 1 year previously. The second case was a 9-year-old girl with a history of injury at the age of 3 months. She developed eye deviation and proptosis for 1 year. Computed tomography scan is excellent for demonstrating bony defects in the orbital roof, while magnetic resonance imaging is more sensitive in showing the intraorbital extension of a leptomeningeal cyst. Both patients were operated successfully and proptosis disappeared postoperatively. The exact pathophysiology of growing fractures is still debated in the literature, but a dural laceration along a fracture line is noted in all cases, and frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing fractures of the orbital roof should be suspected if ocular symptoms appear in a child who had sustained a head injury several months or years before.

Isolated orbital roof fracture: Can it be catastrophic?

“…Like growing fracture of the skull, orbital roof-growing fractures are commonly seen in infants and children. [ 11 12 ] Cerebral pulsation and normal growth of the brain and cranium of the children are responsible for the growth of the fracture. [ 13 ]…”

“…The most common surgical approach described in the literature is frontobasal approach. [ 11 12 ] Recently, di Somma et al . described a minimally invasive combined supra-transorbital keyhole approach for the reconstruction of delayed orbital encephalocele.…”

Posttraumatic giant fronto-orbito encephalocele causing cosmetic disfiguring forehead swelling with proptosis: Management

“…Involvements of orbit are extremely rare. [ 1 2 3 4 5 6 ] In the most of reported orbital growing fracture, defect in such cases is usually small and often limited to the orbital roof only. These cases commonly present with proptosis and visual symptoms.…”

“…[ 7 ] Suri and Mahapatra observed the presence of orbital fracture and associated dural tear was observed in both the cases. [ 3 ] Suri and Mahapatra also concluded frontonasal brain injury play an important role in the growing skull fracture pathogenesis. [ 3 ]…”

“…[ 3 ] Suri and Mahapatra also concluded frontonasal brain injury play an important role in the growing skull fracture pathogenesis. [ 3 ]…”