Pediatric orbital floor fracture

Isolated orbital floor fractures in the paediatric patient: case series and review of management

“…Other studies cite the incidence of nausea and vomiting in 21-28% of cases. 5,14,17 Six of the nine operative patients in this study experienced vomiting and four patients had multiple episodes. Of the 13 non-surgical cases, three were documented as experiencing vomiting, although two of these had concurrent head injuries which could have accounted for this symptom.…”

“…Studies regarding the management of orbital floor trauma in the paediatric population remain limited, with only a few pertaining to orbital floor fractures involving operative managment. 6,[12][13][14] In a review of the literature, 15 significant differences were noted between paediatric and adult patients, which included the mode of clinical presentation, differing fracture patterns, and the need for earlier intervention in the symptomatic group, as well as the expectation of a slower and poorer outcome in paediatric orbital floor fractures. 6,16 It was generally recorded that surgical intervention rates increase with the age of the patient.…”

“…8 Paediatric isolated orbital floor fractures Intervention in the paediatric orbit is advocated earlier than in the adult population. 5,[12][13][14] It has been suggested that the timing of paediatric orbital surgery can be classified as immediate (0-48 h), early (3-14 days), and late (15 days or more), with a greater urgency for trapdoor fracture, 18 yet other authors have suggested that early surgery in the paediatric population may include up to several days post-injury. 21 While early treatment of a 'white-eye' orbital floor fracture may not be indicated from the clinical presentation alone, the radiological diagnosis of the trapdoor fracture with entrapped soft tissue/muscle contents may represent a surgical emergency requiring prompt management to avoid a poorer outcome if delayed beyond 48 h. 13,22 The unique nature of 'trapdoor' fractures 4 and the resulting entrapment of adjacent extraocular muscles is also thought to result in a degree of muscle compartment pressure and subsequently ischaemia, as has been described in orthopaedic injuries.…”

“…It has been noted that diplopia in patients under 9 years of age takes twice as long to resolve as that in older paediatric patients (10-15 years). 6 Whatever the mechanism of soft tissue injury, early intervention is associated with a superior outcome in trapdoor fractures, 5,14,21 and surgery is therefore recommended within 2 days in this population. 13 It is possible that due to the rapid bone turnover in young patients, early callus formation may make surgical reduction more challenging and contribute to poorer outcomes.…”

An Analysis of 733 Surgically Treated Blowout Fractures

“…De Man et al [1] reported that 14 of 15 blowout fractures of the inferior orbit in children were trapdoor fractures, and Egbert et al [23] reported that 61.8% of pediatric patients had the trapdoor type. In our hospital, 66 of the 144 cases (45.8%) were of the trapdoor or linear type, which was in contrast to the result of the adult group, i.e.…”