Posttraumatic subperiosteal orbital hematoma

Clinico-radiological features and treatment outcomes in children with traumatic orbital subperiosteal hematoma

PURPOSE

To study the clinical findings, imaging features, and treatment outcomes in children diagnosed with traumatic orbital subperiosteal hematoma (OSpH).

METHODS

The medical records of eligible OSpH children treated either via needle aspiration or open surgical drainage were reviewed retrospectively. Three anatomical factors (inferior globe displacement, superior orbital sulcus fullness, extraocular movements) and two functional parameters (visual acuity, pupillary reactions) were used to determine overall success.

RESULTS

A total of 10 children (mean age, 6.8 years; 8 males) were included. All had a history of blunt trauma, unilateral presentation, inferior globe displacement, fullness of superior orbital sulcus, and raised retrobulbar resistance. Diminution of vision and restricted elevation was noted in 7 children, and 4 had a relative afferent pupillary defect. Computed tomography (CT) revealed superior OSpH in all 10 children and, additionally, orbital wall fracture in 4. Needle aspiration of the OSpH was performed in 8 children; 2 underwent open surgical drainage. At a mean follow-up of 8.5 months, all children showed satisfactory improvement in both anatomical and functional parameters:1 child had a persistent nebulomacular corneal opacity, and 1 had minimal upper eyelid edema.

CONCLUSIONS

A high index of suspicion, appropriate radiology (CT of orbits), and early management through needle aspiration of OSpH may help in early and satisfactory anatomical and functional outcomes.

Spontaneous subperiosteal orbital hematoma as initial presentation of metastatic lung adenocarcinoma to the skull: case report

INTRODUCTION

Subperiosteal orbital hematoma is a rare occurrence, typically developing as a result of orbital trauma. The spontaneous formation of a subperiosteal orbital hematoma (sSOH) may also occur but is less frequent. To date there has been no documented cases of sSOH as the initial presentation of an unknown metastatic neoplasm to the skull. We provide a case of a woman with unknown lung adenocarcinoma that metastasized to the skull which caused the formation of a sSOH resulting in orbital compression syndrome.

CASE REPORT

A 57-year-old female presented with double vision, retro-orbital right eye pain, and vision loss in the right eye. A magnetic resonance imaging revealed a right orbital compressive lesion with an adjacent supraorbital skull lesion and separate left frontal skull lesion. Intra-operative findings along with post-operative immunohistochemistry staining revealed sSOH resulting from a metastatic lung adenocarcinoma to the skull. Further metastatic work up also revealed an occult lung mass and multiple spinal lesions.

CONCLUSION

Differential diagnosis of etiologies causing the formation of sSOH in an adult without history of trauma should include metastatic neoplasm to the skull and warrants metastatic workup. Treatment options of sSOH have included observation with spontaneous resolution; however, we opted for surgical decompression of the eye and biopsy of the skull mass.

Occurrence, types and severity of associated injuries of paediatric patients with fractures of the frontal skull base

OBJECTIVES

To clarify the occurrence, sites, and types of associated injuries in paediatric patients with fractures of the anterior skull base.

STUDY DESIGN

Retrospective analysis of files of 49 patients aged up to 18 years.

RESULTS

Associated injuries were observed in 91.8% of the patients. Observed most frequently were fractures of the skull vault (85.7%), brain injury (59.2%), facial fracture (42.9%), lung contusion (18.4%) and fractures of the upper extremities (14.3%). Multiple injuries were observed in 55.1% and polytrauma in 42.9%. The mortality rate was 10.2%.

CONCLUSIONS

Paediatric patients with fractures of the anterior skull base frequently present with associated injuries, with many having, multiple associated injuries including polytrauma. These patients should be treated in multidisciplinary trauma units.