Pediatric orbital blowout fractures

Abstract

Most cases of pediatric orbital fracture can initially be followed conservatively to determine if disabling diplopia, when present, resolves without surgery. A notable exception is the trapdoor fracture, in which herniated tissue becomes entrapped by a recoiled bone fragment, causing marked or complete reduction in motility and/or an oculocardiac reflex; we recommend that these fractures be repaired within 24 h from the time of diagnosis. Enophthalmos resulting from an orbital floor fracture does not need to be prevented with early surgery. Enophthalmos can be allowed to develop over time to determine if it is noticeable, and then repair undertaken, if necessary, at that time. When surgery is indicated, a simple transconjunctival incision is preferred over a cutaneous incision, and care should be taken to insure that the implant is placed on the bony ledge at the posterior edge of the defect. Many children with blowout fractures will not require surgery, and those that do usually have excellent outcomes provided the recommendations are closely followed.

Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

“…In light of these disclaimers, it may not be surprising that, in this cohort, no significant relationships were found between clinical outcome parameters and implant design options or (small) differences in implant position parameters. The effect of implant position on the clinical outcome has been the subject of debate in the literature, with some authors regarding this as a key factor determining the clinical outcome 42,43 , while others have hypothesized that its role is not as important as previously believed 44 . Differences in confounding factors, especially defect size, make it difficult to reach any definitive conclusions based on the literature.…”

Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

“…Consequently, we suggest that operations should be performed for BOF patients with operative indication within 2 weeks after injury [7] or within 4 weeks at the latest, based on our own experience. By contrast, most TF in children should be reconstructed within 24 h because entrapment of the inferior rectus muscle can engender cicatrization and unrecoverable diplopia [8,9]. Operations for our patients were conducted around 24 h after injury (Case 9: 6 h, Case 10: 26 h, Case 11: 7 h), leading to complete recovery.…”

Delayed surgical treatment of orbital trapdoor fracture in paediatric patients

“…Wei and Durairaj5  recommended a prompt surgery within 48 hours of diagnosis after a review of 25 articles about paediatric orbital trapdoor fracture with muscular entrapment. Chung and Langer2 reviewed the recent literature on paediatric orbital blowout fractures and recommended a surgery within 24 hours from the time of diagnosis. A long-term entrapment of extraocular muscle will cause insufficiency in the blood flow, and the resultant ischaemia will lead to fibrosis and muscular dysfunction, presenting as a high rate of persistent diplopia and restricted ocular mobility 4.…”