Natural Course of Orbital Roof Fractures

Stam, Liselotte H. M.; Wolvius, Eppo B.; Schubert, Warren

doi:10.1055/s-0034-1378188

Cited by 8 publications

(6 citation statements)

References 12 publications

(26 reference statements)

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“…In one case series of four patients with significantly displaced blow-in or blow-out orbital roof fractures but without serious neurologic or visual compromise at presentation, the authors noted healing of fractures without sequelae 25. They postulated that the equilibrium between intraorbital and intracranial pressures led to their resolution 25. Nevertheless, this equilibrium can be disturbed with increasing intracranial pressures or dural laceration, or both, in the setting of a minimally displaced but unstable orbital roof due to extensive comminution, as seen in both patients we present.…”

Section: Discussionmentioning

confidence: 99%

“…However, some authors argue that the degree of displacement alone does not predict development of serious complications 1. In one case series of four patients with significantly displaced blow-in or blow-out orbital roof fractures but without serious neurologic or visual compromise at presentation, the authors noted healing of fractures without sequelae 25. They postulated that the equilibrium between intraorbital and intracranial pressures led to their resolution 25.…”

Section: Discussionmentioning

confidence: 99%

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Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

Mangham

Frommer

et al. 2017

Craniomaxillofacial Trauma & Reconstruction

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Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. They are typically associated with severe mechanisms of injury and may be associated with significant neurologic or ophthalmologic compromise including traumatic brain injury and vision loss. Rarely, traumatic encephalocele or pulsatile exophthalmos may be present at the time of injury or develop in delayed fashion, necessitating close observation of these patients. In this article, we describe two patients with minimally displaced blow-in type orbital roof fractures that were later complicated by orbital encephalocele and pulsatile exophthalmos, prompting urgent surgical intervention. We also suggest a management algorithm for adult patients with orbital roof fractures, emphasizing careful observation and interdisciplinary management involving plastic surgery, neurosurgery, and ophthalmology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

Mangham

Frommer

et al. 2017

Craniomaxillofacial Trauma & Reconstruction

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“…However, although case series and reports describe the results and complications associated with intervention or conservative treatment, intervention rates vary widely. 7,8,10,18,[29][30][31][32] Moreover, there are no randomized controlled trials to help guide intervention decisions and intervention rates vary according to surgeons and establishments, particularly when the anterior cranial fossa is involved.…”

Section: Orfmentioning

confidence: 99%

The Management of Orbital Roof Fractures and Defects: A Review

Sandhu

Bucur²,

Good

et al. 2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases. Methods: A review of the current literature through the MEDLINE database using the following search terms: “orbital roof fracture (+treatment/management),” “orbital roof defect (+treatment/management),” “orbital roof erosion (+treatment/management),” “orbital roof repair,” “orbital roof,” “orbital fracture,” “pediatric orbital roof (defect/fracture/erosion),” “orbital anatomy,” and “orbital roof anatomy” was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise. Results: The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD. Conclusion: Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.

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“…A nonsurgical approach can be considered in the absence of intracranial or orbital symptoms, such as diplopia or cerebrospinal fluid (CSF) leak, and patients can be given a strict follow-up protocol for several weeks with routine CT scans. 5 If patients have intracranial or infraorbital injury or develop neurologic or ocular symptoms, surgical management is then considered to remove impinging bony fragments, repair dura, or reconstruct the orbital roof. 25 Early decompression is also warranted in the presence of pressure effect, as delay in decompression can result in delayed recovery of vision.…”

Section: Managementmentioning

confidence: 99%

“…1 Currently, orbital roof fracture management lacks a defined methodology to determine surgical intervention versus conservative management, although the first step in directing a management plan is often to classify the fracture as isolated or nonisolated. 5 Early surgical intervention has been traditionally advocated for nonisolated cases to prevent complications such as meningitis, encephalocele, and brain abscess formation. 1,2,4,6 Another factor commonly considered when deciding on management is whether the fracture is displaced or nondisplaced.…”

Section: Introductionmentioning

confidence: 99%

Orbital Roof Fractures: An Evidence-Based Approach

Lucas

Allen

Nguyen

et al. 2020

Facial Plastic Surgery & Aesthetic Medicine

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Importance: There is controversy surrounding the management of orbital roof fractures. Guidelines with regard to when to operate and type of reconstruction are lacking. Categorizing these data will help clinicians make informed decisions about the management of orbital roof fractures and avoid preventable complications.Objective: To perform a systematic review evaluating underlying causes, associated complications, and management of orbital roof fractures including reconstructive options in the general population of children and adults. Evidence Review: A systematic review using the PubMed, EmBase, Cochrane, and MEDLINE databases identified relevant studies for inclusion. Studies were included from 1987 to 2017. Demographics, symptoms, management, reconstruction, and outcomes were reported following preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria included articles discussing management of traumatic orbital roof fractures across all ages. Included studies were assessed for level of evidence. Findings: Forty-seven studies encompassing 526 patients met inclusion criteria. There were 28 case reports, 15 retrospective case series and 4 retrospective cohort studies. The most common etiologies were motor vehicle accidents (39.5%), falls (30.3%), and assault (11.8%). Periorbital ecchymosis, exophthalmos, and dystopia were the most common initial symptoms. In total, 60.0% of patients underwent surgical repair and 40% of patients were managed conservatively. The most common surgical approach was bicoronal (94.8%), followed by a superolateral orbital rim approach and transpalpebral (5.1%). A variety of grafting materials were utilized, including titanium miniplates (46.2%), bone graft (37.7%), porous polyethylene (2.8%), and silastic implants (2.8%). Overall patients undergoing surgery were adults with clinical symptoms including exophthalmos, diplopia, and gaze restriction as well as patients with dura exposure. Most patients undergoing surgery were those with concomitant fractures. The most common fractures among the surgical patients were frontal bone (32.2%), ethmoid (25.2%), and zygomaticomaxillary complex/zygoma (12.2%). Conclusions and Relevance: Management of orbital roof fractures varies based on individual clinical features including the presence of exophthalmos, gaze restriction, and concomitant injuries such as dural tears. Surgically, bicoronal approaches were performed most commonly along with reconstruction utilizing titanium miniplates. Conservative management was more common among the pediatric population. This systematic review demonstrates both conservative and surgical measures can lead to positive outcomes in appropriately selected patients.

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Natural Course of Orbital Roof Fractures

Cited by 8 publications

References 12 publications

Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

The Management of Orbital Roof Fractures and Defects: A Review

Orbital Roof Fractures: An Evidence-Based Approach

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