Isolated paediatric orbital fractures: a case series and review of management at a major trauma centre in the UK

Abstract

Purpose Paediatric orbital fractures are rare. Existing literature demonstrates wide variation in estimates of incidence, aetiology, management protocols and outcomes. Despite this, it is generally acknowledged that orbital fractures with entrapment of the extraocular muscles constitute a surgical emergency due to the potential for persistent diplopia secondary to muscle ischaemia and necrosis. Methods This retrospective study was conducted to determine the characteristics and outcomes of management of orbital fractures amongst the paediatric population. It involved patients presenting to a major trauma unit in London between 2010 and 2020. Results Thirteen patients with isolated orbital fractures presented to our unit in this period. The average age was 13 years. Surprisingly the predominant aetiology was interpersonal violence. The most common fracture pattern involved the orbital floor and medial wall. One medial wall fracture case was missed in the emergency department. Eight patients required surgical intervention due to diplopia caused by muscular entrapment of extraocular muscles; the final patient had a large defect resulting in enophthalmos requiring a large titanium plate. A transconjuctival approach was preferred for surgical access and resorbable sheet was used in the remaining cases. Five patients had nausea, vomiting or bradycardia associated with the oculocardiac reflex. Surgical intervention occurred within 24–48 h of injury in 6 cases. Resolution of diplopia occurred in 7 patients within 6 months. Conclusion Paediatric patients with orbital fractures should be assessed on the day of injury by a maxillofacial surgeon. Due to the risk of persistent diplopia, urgent surgical intervention in patients with entrapment of extraocular muscles should occur as soon as possible.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement

“…A prevalence of 44.6% has been reported for extraocular muscle entrapment associated with diplopia, enophthalmos, and limitation of eye movements, especially associated with burst fractures of the orbital floor and medial wall [65,66]. The cause of diplopia in extraocular muscle entrapment is ischemia in the ocular muscles and then permanent damage due to Volkmann's contracture [67]. Oculocardiac reflex, which may manifest itself with bradycardia, nausea, and vomiting, may be seen due to extraocular muscle entrapment [68].…”

Comprehensive Management of Pediatric Orbital Fractures: A Case Series and Review of Literature

“…Maxillofacial fractures are rarely evident in the pediatric population, with an incidence rate of less than 15% [ 1 ]. Among pediatric maxillofacial fractures, the orbital fracture is the least reported fracture type (9%) in comparison to mandibular (32.7%), nasal (30.2%), and maxillary/zygomatic fractures (28.6%) [ 2 ].…”