1
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Ambat JM, Someda SK, Takahashi Y. Clinical characteristics and associated features of pure orbital roof fractures: A ten-year retrospective review. J Plast Reconstr Aesthet Surg 2024; 94:32-37. [PMID: 38754270 DOI: 10.1016/j.bjps.2024.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To present the demographics and clinical characteristics of pure (rim-sparing) orbital roof fractures. METHODS This retrospective observational study used 10 years of data from a single institution. Patient age, sex, laterality, field of binocular single vision, associated injuries, and radiologic features were analyzed. Orbital roof fractures were categorized into four groups: comminuted/open, hinged, trapdoor, and linear. These were further subdivided into blow-in (-down) and blow-out (-up) fractures. Injury etiology was classified into fall, traffic accidents, sports injuries, assault, work-related, and others. RESULTS Data documented a low incidence rate of 2.5% (27 patients) in 1074 patients. Most patients were male (81%). The most common cause of injury was fall (48%), followed by traffic accidents (22%). Comminuted/open fractures constituted the bulk of fracture types (54%), followed by hinged, and linear fractures. Blow-in and blow-out fractures had an incidence rate of 50% each. Concomitant fractures of the medial and inferior orbital walls were predominant. Low surgical intervention was noted owing to acceptable field of binocular single vision outcomes, and the field of binocular single vision included the primary position of gaze in 88% of patients. CONCLUSION Pure orbital roof fractures occurred in 2.5% of patients with pure orbital fractures. Patients were predominantly male with trauma caused by high energy forces, which regularly caused comminution of the roof and fractures of the medial and inferior orbital walls. Most patients were managed conservatively.
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Affiliation(s)
- Jose M Ambat
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
| | - Steffani K Someda
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan.
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2
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Maheshwari M, Ho ML, Bosemani T, Dahmoush H, Fredrick D, Guimaraes CV, Gulko E, Jaimes C, Joseph MM, Kaplan SL, Miyamoto RC, Nadel HR, Partap S, Pfeifer CM, Pruthi S. ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. J Am Coll Radiol 2024; 21:S219-S236. [PMID: 38823946 DOI: 10.1016/j.jacr.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Mai-Lan Ho
- Panel Vice Chair, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Hisham Dahmoush
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Douglas Fredrick
- Oregon Health & Science University-Casey Eye Institute, Portland, Oregon; American Academy of Pediatrics
| | | | - Edwin Gulko
- Westchester Medical Center, Valhalla, New York
| | - Camilo Jaimes
- Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Summer L Kaplan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Committee on Emergency Radiology-GSER
| | - R Christopher Miyamoto
- Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, Indiana; American Academy of Otolaryngology-Head and Neck Surgery
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
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3
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Fu Y, He Y, Xie H, Sun K, Dai H. Closed head injury combined with orbital blowout fracture and displacement of the eyeball into the maxillary sinus in a 14-year-old boy: a case report. BMC Ophthalmol 2024; 24:146. [PMID: 38566099 PMCID: PMC10988962 DOI: 10.1186/s12886-024-03421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/30/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare. CASE PRESENTATION We present the case of a 14-year-old with a closed head injury, OBF, and displacement of the eyeball into the maxillary sinus following a car accident. A prompt transconjunctival access surgery was performed for eyeball repositioning and orbital reconstruction in a single session, mitigating anaesthesia-related risks associated with multiple surgeries. At the 12-month follow-up, his visual acuity was 20/200. Despite limited eye movement and optic nerve atrophy, overall satisfaction with the ocular appearance was achieved. CONCLUSIONS This report offers novel insights into the mechanisms of OBF occurrence and the development of postoperative complications.
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Affiliation(s)
- Yue Fu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying He
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huixuan Xie
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kongliang Sun
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Hanjun Dai
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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4
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Etheridge T, Brintz BJ, Jensen MS, Peralta E, Ayesha A, Jebaraj A, Marx DP. Incidence and severity of asymptomatic ocular injury in adult and pediatric orbital fractures. Orbit 2023; 42:273-278. [PMID: 35801838 PMCID: PMC9943542 DOI: 10.1080/01676830.2022.2095648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures. METHODS We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests. RESULTS Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (p-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%). CONCLUSIONS Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.
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Affiliation(s)
- Tyler Etheridge
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Ben J. Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Michael S. Jensen
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Esteban Peralta
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Azraa Ayesha
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Abigail Jebaraj
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Douglas P. Marx
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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5
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Review of 451 Patients Presenting With Orbital Wall Fractures: A Retrospective Analysis. J Craniofac Surg 2023; 34:126-130. [PMID: 35994738 DOI: 10.1097/scs.0000000000008959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/15/2022] [Indexed: 01/11/2023] Open
Abstract
A retrospective review of the electronic medical records of patients presenting to the University Medical Center in Lubbock, Texas with orbital wall fractures. Clinical data such as associated ocular injuries and different management approaches are analyzed and discussed to help clarify the specific indications for, and timing of, a formal ophthalmologic examination. All patients who presented to the emergency department for an orbital fracture after suffering various types of traumas between 2008 and 2017 were included. The study reviewed 451 patients with orbital wall fractures with a wide variety of presentations as well as demographics. There were 411 cases of adults presenting with an average age of 34 years and 40 pediatric presentations with an average age of 14 years. The average age of the combined study population was 30 years. Only 16.9% of patients required surgical correction for their orbital fractures and assault accounted for nearly 50% of all the orbital fractures reviewed in this study. In this large retrospective review, no notable relationship was found between orbital wall fractured and ocular injury. Alarm symptoms for more visual threatening injuries such as retinal tears, detachments, open globe injury, and extraocular muscle entrapment are all reasonable indications to consult ophthalmology emergently. Most orbital fractures are not vision threatening, do not usually require surgical correction, and typically occur in the setting of assault.
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6
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Orbital fracture with involvement of the lacrimal sac in a child. J Fr Ophtalmol 2022; 45:e423-e425. [DOI: 10.1016/j.jfo.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022]
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7
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Isolated paediatric orbital fractures: a case series and review of management at a major trauma centre in the UK. Oral Maxillofac Surg 2022:10.1007/s10006-022-01056-z. [PMID: 35312892 PMCID: PMC8936037 DOI: 10.1007/s10006-022-01056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/06/2022] [Indexed: 11/08/2022]
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.
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8
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Sandhu PS, Bucur S, Good C, Cutler M, Rajak S. The Management of Orbital Roof Fractures and Defects: A Review. Ophthalmic Plast Reconstr Surg 2022; 38:8-16. [PMID: 34293784 DOI: 10.1097/iop.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
| | | | - Catriona Good
- Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Mark Cutler
- Department of Head & Neck Prosthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Saul Rajak
- Orbital and Oculoplastics Department, Sussex Eye Hospital
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9
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Halsey J, Argüello-Angarita M, Carrasquillo OY, Hoppe IC, Lee ES, Granick MS. Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center. Craniomaxillofac Trauma Reconstr 2021; 14:183-188. [PMID: 34471473 DOI: 10.1177/1943387520933697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective chart review of pediatric and globe injuries associated with orbital fractures. Objective Our study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures.
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Affiliation(s)
- Jordan Halsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marvin Argüello-Angarita
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Osward Y Carrasquillo
- Department of Dermatology, University of Puerto Rico School of Medicine, Puerto Rico
| | - Ian C Hoppe
- Department of Plastic Surgery, University of Mississippi College of Medicine, Jackson, MS, USA
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark S Granick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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10
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Chen YH, Tsai YJ, Tzeng IS. Factors influencing surgical outcomes in orbital trapdoor fracture. Sci Rep 2021; 11:17547. [PMID: 34475434 PMCID: PMC8413308 DOI: 10.1038/s41598-021-96920-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/12/2022] Open
Abstract
This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post-operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p = 0.02), muscle incarceration (p = 0.01), duration from injury to surgical reduction (p = 0.004), and postoperative supra-duction limitation (p = 0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.
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Affiliation(s)
- Yi-Hua Chen
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing St., Guishan Dist., Taoyuan City, 33375, Taiwan.,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan city, 33302, Taiwan
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing St., Guishan Dist., Taoyuan City, 33375, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan city, 33302, Taiwan.
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, No.289, Jiang-Kuo Rd., Xindian Dist., New Taipei City, 231, Taiwan
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11
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Reed DS, Davies BW, Durairaj VD. Re: "Orbital Roof Fractures: An Evidence-Based Approach" by Lucas et al. Facial Plast Surg Aesthet Med 2021; 23:152. [PMID: 33724886 DOI: 10.1089/fpsam.2020.0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Donovan S Reed
- Texas Oculoplastics Consultants (TOC) Eye and Face, Austin, Texas, USA
| | - Brett W Davies
- Texas Oculoplastics Consultants (TOC) Eye and Face, Austin, Texas, USA
| | - Vikram D Durairaj
- Texas Oculoplastics Consultants (TOC) Eye and Face, Austin, Texas, USA
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12
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Dryden SC, Meador AG, Johnston AB, Eder AE, Fleming JC, Fowler B. Pediatric Orbital Roof Fractures: A Ratio of Orbital Dimensions Correlated to Prevalence of Fracture. J Neurol Surg B Skull Base 2020; 83:281-284. [DOI: 10.1055/s-0040-1721821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/25/2020] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objective Orbital roof fractures are more likely to occur in younger children, specifically younger than 7 years. Cranium to face ratio decreases with age; however, there is no definition for measurement of the neurocranium or face. We propose using the length of the orbital roof as a measurement of the neurocranium and length of the orbital floor as a tool to estimate midface size. The purpose of this study is to test this measurement as a correlation rate of orbital roof fractures within the pediatric population.
Design This is a retrospective study.
Setting This study was done at the LeBonheur Children's Hospital.
Participants Sixty-six patients with orbital roof fractures were identified and stratified by gender and age, specifically younger than 7 years and 7 years or older.
Main Outcome Measures The main outcome measures were orbital roof length, floor length, and ratio thereof.
Results Mean orbital roof length was 43.4 ± 3.06 and 45.1 ± 3.94 mm for patients <7 and ≥7 years, respectively (p = 0.02). Mean orbital floor length was 41.3 ± 2.99 and 47.7 ± 4.19 for patients <7 and ≥7 years, respectively (p < 0.00001). The mean roof to floor ratio (RTFR) for patients <7 years was 1.051 ± 0.039 and for patients ≥ 7 years was 0.947 ± 0.031 (p < 0.00001).
Conclusion As children age, the relative length of the orbital roof decreases when compared with the orbital floor. The RTFR was more than 1.0 in children younger than 7 years. These differences were statistically significant when compared with children 7 years and older. This measurement shift follows the differences noted in orbital fracture patterns during childhood.
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Affiliation(s)
- Stephen C. Dryden
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andrew G. Meador
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andrew B. Johnston
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Adrianna E. Eder
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - James C. Fleming
- Department of Ophthalmology, Veterans Administration Hospital, Memphis, Tennessee, United States
| | - Brian Fowler
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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13
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Lucas JP, Allen M, Nguyen BK, Svider PF, Folbe AJ, Carron M. Orbital Roof Fractures: An Evidence-Based Approach. Facial Plast Surg Aesthet Med 2020; 22:471-480. [DOI: 10.1089/fpsam.2020.0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordyn P. Lucas
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Meredith Allen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Brandon K. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Peter F. Svider
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Adam J. Folbe
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Michael Carron
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
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14
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Gowda AU, Manson PN, Iliff N, Grant MP, Nam AJ. Resolution of Vertical Gaze Following a Delayed Presentation of Orbital Floor Fracture With Inferior Rectus Entrapment: The Contributions of Charles E. Iliff and Joseph S. Gruss in Orbital Surgery. Craniomaxillofac Trauma Reconstr 2020; 13:253-259. [PMID: 33456696 DOI: 10.1177/1943387520965804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Orbital floor fractures occur commonly as a result of blunt trauma to the face and periorbital region. Orbital floor fractures with a "trapdoor" component allow both herniation and incarceration of contents through a bone defect into the maxillary sinus as the bone rebounds faster than the soft tissue, trapping muscle, fat, and fascia in the fracture site. In children, the fractured floor, which is often hinged on one side, tends to return toward its original anatomical position due to the incomplete nature of the fracture and elasticity of the bone. The entrapment of the inferior rectus muscle itself is considered a true surgical emergency-prolonged entrapment frequently leads to muscle ischemia and necrosis leading to permanent limitation of extraocular motility and difficult to correct diplopia. For this reason, prompt surgical intervention is recommended by most surgeons. In adults, true entrapment of the muscle itself is not as common because the orbital floor is not as elastic and fractures are more complete. Methods We present an adult patient with an isolated orbital floor fracture with clinical and radiologic evidence of true entrapment of the inferior rectus muscle itself. Results Despite the delayed surgical repair (4 days after the injury), the patient's inferior rectus muscle function returned to near normal with mild upward gaze diplopia. Conclusions Inferior rectus entrapment in adults may more likely be associated with immobilization of the muscle without total vascular compression/incarceration significant enough to lead to complete ischemic necrosis.
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Affiliation(s)
- Arvind U Gowda
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Iliff
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Wilmer Institute of Opthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Arthur J Nam
- Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Kim SH, Choi JH, Hwang JH, Kim KS, Lee SY. Surgical indication analysis according to bony defect size in pediatric orbital wall fractures. Arch Craniofac Surg 2020; 21:276-282. [PMID: 33143394 PMCID: PMC7644352 DOI: 10.7181/acfs.2020.00409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods We retrospectively reviewed the charts of patients aged 0–15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results A total of 305 pediatric patients with pure orbital fractures were included–257 males (84.3%), 48 females (15.7%); mean age, 12.01± 2.99 years. The defect size (p= 0.002) and fracture type (p= 0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p< 0.001). Pearson’s correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p= 0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 cm2 was obtained (sensitivity, 0.543; specificity, 0.724; p= 0.002). Conclusion The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 cm2 may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.
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Affiliation(s)
- Seung Hyun Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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Clinical Decision Rule to Identify Orbital Wall Fracture Among Children: Retrospective Derivation and Validation Study. Pediatr Emerg Care 2020; 36:e280-e284. [PMID: 29016519 DOI: 10.1097/pec.0000000000001300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department. METHODS This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers. Among 16 candidate clinical variables, 13 clinical signs and symptoms were selected as clinical predictors. For the fracture model, these clinical predictors were analyzed by 3-fold cross-validation. Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve in both cohorts. RESULTS Four variables (orbital rim tenderness, periorbital ecchymosis, painful extraocular movement, and nausea/vomiting) had the best predictive model with the highest AUROC value. The AUROC values for fracture prediction were 0.793 (95% confidence interval, 0.741-0.844) and 0.809 (95% confidence interval, 0.742-0.877) in the derivation cohort and validation cohort, respectively. The sensitivity and negative predictive values were 96.4% and 93.4%, respectively, in the derivation cohort, and 97.8% and 98.1%, respectively, in the validation cohort. The sum of these scores ranged from 0 to 4. Patients with a sum of scores of 1 or higher showed significantly increased risk for fracture. CONCLUSIONS The 4-variable predictive model can be useful for finding clinically important orbital wall fractures in children.
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Valente L, Tieghi R, Elia G, Galiè M. Orbital Fractures in Childhood. Ann Maxillofac Surg 2020; 9:403-406. [PMID: 31909024 PMCID: PMC6933969 DOI: 10.4103/ams.ams_185_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pediatric orbital floor fractures exhibit distinctive features that distinguish them from orbital injuries seen in the adult population. This is mainly due to different anatomy and mechanical properties of the orbital bones in children. The management of pediatric orbital floor fractures requires consideration of these factors, including the age of the patient and therefore child's growth potential, using, if possible, a minimally invasive surgical approach. The aim of this paper is to report a case of a 1-year-old male child with a surgically treated blowout fracture of the orbital floor. To enable early diagnosis and treatment, accurate physical examination is mandatory, but a computed tomographic examination is important, especially in younger patients because of their inability to fully express their symptoms and poor compliance. We discuss the specific presentation and diagnostics of orbital floor fractures in early childhood and the related surgical planning and treatment.
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Affiliation(s)
- Luisa Valente
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Riccado Tieghi
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Giovanni Elia
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
| | - Manlio Galiè
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, St. Anna Hospital and University, Ferrara, Italy
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Traumatic Telecanthus and Posterior Lacrimal Crest Avulsion in a Six-Year-Old Child. J Craniofac Surg 2019; 30:2224-2226. [DOI: 10.1097/scs.0000000000005922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Paasche A, Bettoni J, Capel C, Peltier J, Dakpé S. A case of pulsatile proptosis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:99-101. [PMID: 31336211 DOI: 10.1016/j.jormas.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- A Paasche
- Maxillofacial Surgery Department, Amiens University Hospital, Avenue Laennec, 80000 Amiens, France.
| | - J Bettoni
- Maxillofacial Surgery Department, Amiens University Hospital, Avenue Laennec, 80000 Amiens, France
| | - C Capel
- Neurosurgery Department, Amiens University Hospital, Avenue Laennec, 80000 Amiens, France
| | - J Peltier
- Neurosurgery Department, Amiens University Hospital, Avenue Laennec, 80000 Amiens, France
| | - S Dakpé
- Maxillofacial Surgery Department, Amiens University Hospital, Avenue Laennec, 80000 Amiens, France
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Park J, Baek S. Management of pediatric orbital wall fractures. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2018.1560266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sehyun Baek
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Barh A, Swaminathan M, Mukherjee B. Orbital fractures in children: clinical features and management outcomes. J AAPOS 2018; 22:415.e1-415.e7. [PMID: 30366051 DOI: 10.1016/j.jaapos.2018.07.353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the clinical characteristics and management outcomes of orbital fractures in children. METHODS The medical records of pediatric patients (<18 years of age) who presented with orbital fractures over a 15-year period (January 2001-December 2015) were reviewed retrospectively. The cause of injury, imaging findings, clinical features, management, and outcomes were noted. RESULTS A total of 52 patients (39 males) were included. Mean age at presentation was 10.9 years (range, 2-18). Road traffic accidents (18/52 [35%]) were the most common cause, with the orbital floor (42/52 [81%]) being the most common fracture site. The most common complaint was double vision (52%). Thirty-eight patients underwent surgical intervention, and extraocular muscle entrapment (56%) was the most common indication for surgery. Early surgical intervention within 15 days of injury resulted in complete resolution of diplopia. CONCLUSION In our study cohort, orbital floor fracture was most common. The trapdoor type of fracture was seen in almost half of the patients, with diplopia being the most common presenting complaint. Early surgical intervention was associated with complete resolution of ocular motility limitation and diplopia.s.
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Affiliation(s)
- Atanu Barh
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetics, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Meenakshi Swaminathan
- Department of Pediatric Ophthalmology & Strabismus, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetics, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
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Effect of Time to Operative Intervention on Motility Outcomes Following Orbital Floor Fracture Repair in Children. Ophthalmic Plast Reconstr Surg 2018; 34:351-354. [DOI: 10.1097/iop.0000000000000993] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kennedy TA, Corey AS, Policeni B, Agarwal V, Burns J, Harvey HB, Hoang J, Hunt CH, Juliano AF, Mack W, Moonis G, Murad GJ, Pannell JS, Parsons MS, Powers WJ, Schroeder JW, Setzen G, Whitehead MT, Bykowski J. ACR Appropriateness Criteria® Orbits Vision and Visual Loss. J Am Coll Radiol 2018; 15:S116-S131. [PMID: 29724415 DOI: 10.1016/j.jacr.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 01/22/2023]
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Yoo YJ, Yang HK, Kim N, Hwang JM. Pediatric orbital wall fractures: Prognostic factors of diplopia and ocular motility limitation. PLoS One 2017; 12:e0184945. [PMID: 29095826 PMCID: PMC5667750 DOI: 10.1371/journal.pone.0184945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/02/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture. DESIGN Retrospective observational case series. METHODS In this retrospective observational case series, 150 pediatric patients (1-18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed. RESULTS Of the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19-2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07-1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54-8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45-9.82) were found as negative prognostic factors for the recovery of motility limitation. CONCLUSIONS Presence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Takahashi Y, Sabundayo MS, Miyazaki H, Mito H, Kakizaki H. Orbital trapdoor fractures: different clinical profiles between adult and paediatric patients. Br J Ophthalmol 2017; 102:885-891. [PMID: 29055906 DOI: 10.1136/bjophthalmol-2017-310890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/13/2017] [Accepted: 10/03/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND To compare clinical findings of orbital trapdoor fractures between adult and paediatric patients. METHODS Paediatric patients were categorised into two groups by age: children (0-9 years) and adolescents (10-19 years). Adult patients were categorised into two groups by age: early (20-44 years) and middle-late adulthood (≥45 years). Demographic data, ocular and periocular complications, CT findings and binocular single vision field (BSVF) were compared among age groups. RESULTS This study included 105 patients (105 sides, 22 children, 59 adolescents, 14 patients in early adulthood and 10 patients in middle-late adulthood). In patients with fractures of the orbital floor and medial wall, both walls presented as trapdoor fractures in paediatric patients, while one wall presented as a non-trapdoor fracture in adult patients (p=0.061). None of the adult patients showed extraocular muscle incarceration, whereas this was present in 8 of 22 children (36.4%) and 7 of 59 adolescents (11.9%) (p=0.005). Hypoesthesia of the infraorbital nerve more frequently occurred in adults (p=0.004). As the preoperative BSVF was larger in adult than in paediatric patients (p=0.007), the percentage of adult patients who underwent surgical reduction of orbital fractures tended to be lower (p=0.058). Postoperative change in BSVF was smaller in adult patients (p=0.005). CONCLUSIONS Fracture pattern, type of incarcerated tissue and incidence of hypoesthesia of the infraorbital nerve were different between adult and paediatric patients. Adult patients had a larger preoperative BSVF and less need for surgical reduction; however, there was less improvement in postoperative BSVF.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Maria Suzanne Sabundayo
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hidetaka Miyazaki
- Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hidenori Mito
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.,Department of Ophthalmology, Ide Eye Hospital, Yamagata, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Abstract
PURPOSE OF REVIEW The current study reviews the recent literature on pediatric orbital blowout fractures and provides guidelines on their management. RECENT FINDINGS The most common problem among patients requiring surgical revision of a previously repaired orbital floor fracture is an improperly placed orbital floor implant, usually erroneously placed under the posterior bony ledge. Although the transconjunctival incision can be combined with a lateral canthotomy and cantholysis, excellent surgical exposure can be obtained without the need for these latter relaxing maneuvers. In surgically repaired pediatric orbital blowout fractures with preoperative diplopia (both trapdoor and nontrapdoor), approximately 85% of patients recover completely over time. Delayed orbital tissue atrophy may play a role in the development of late enophthalmos. SUMMARY 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.
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Yang DJ, Kim YJ, Seo DW, Lee HJ, Park IJ, Sohn CH, Ryoo JM, Lee JS, Kim WY, Lim KS. Characteristics of orbital wall fractures in preschool and school-aged children. Clin Exp Emerg Med 2017; 4:32-37. [PMID: 28435900 PMCID: PMC5385511 DOI: 10.15441/ceem.16.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/28/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the injury patterns in pediatric patients with an orbital wall fracture (OWF) and to identify the differences in injury patterns between preschool and school-aged patients with OWF who presented to the emergency department. Methods We performed a retrospective observational study in the emergency department of a tertiary hospital between January 2004 and March 2014. A total of 177 pediatric patients (<18 years) with OWF who underwent facial bone computed tomography scans with specific discharge codes were included. Patients were categorized into preschool (≤7 years) and school-aged (>7 years) pediatric groups. Results The inferior wall was the most common fracture site in both the preschool and school-aged pediatric groups (50.0% vs. 64.4%, P=0.15). The male-to-female ratio and the mechanism of injury showed significant differences between the two age groups. Violence was the most common mechanism of injury in the school-aged pediatric group (49.3%), whereas falls from a height caused OWF in approximately half of the patients in the preschool pediatric group (42.9%). Concomitant injuries and facial fractures had a tendency to occur more frequently in the school-aged pediatric group. Conclusion Significant differences according to the sex and mechanisms of injury were identified in preschool and school-aged pediatric patients with OWF.
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Affiliation(s)
- Dong Jin Yang
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-June Park
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Min Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Miller KE. Pediatric Ocular Trauma: an Update. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ramphul A, Hoffman G. Does Preoperative Diplopia Determine the Incidence of Postoperative Diplopia After Repair of Orbital Floor Fracture? An Institutional Review. J Oral Maxillofac Surg 2017; 75:565-575. [DOI: 10.1016/j.joms.2016.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/29/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
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Dorafshar AH, Davidson EH, Manson PN. Controversies in the Principles for Management of Orbital Fractures in the Pediatric Population. Plast Reconstr Surg 2017; 139:804e-805e. [PMID: 28234877 DOI: 10.1097/prs.0000000000003122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Amir H Dorafshar
- Department of Plastic and Reconstructive, Surgery Johns Hopkins Hospital, Baltimore, Md
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Kim YJ, Ahn S, Seo DW, Sohn CH, Lee HJ, Park IJ, Yang DJ, Ryoo SM, Kim WY, Lim KS. Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case-control study. BMJ Open 2016; 6:e011110. [PMID: 27645553 PMCID: PMC5030573 DOI: 10.1136/bmjopen-2016-011110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult counterparts. DESIGN A retrospective case-control study. SETTING An emergency department of a university-affiliated hospital located in an urban area. PARTICIPANTS A total of 1378 adult patients with OWF diagnosed by CT from 1 January 2004 through 31 March 2014 were enrolled. Patients were categorised into elderly (≥65 years) and non-elderly (<65 years) groups. RESULTS The elderly group (n=146) had a mean age of 74.0 years compared with 37.5 years in the non-elderly group (n=1232). Slipping was the most common cause of OWF in the elderly group (43.8%, p<0.001), whereas violence was the most common cause in the non-elderly group (37.3%, p<0.001). The lateral orbital wall was the more common site of fracture in the elderly group, and their injuries were more often associated with concurrent facial bone fractures, including the mandible, maxilla and zygoma, compared with the non-elderly group. After adjusting for sex and the mechanism of injury, inclusion in the elderly group was a significant risk factor for fracture of the lateral wall (OR 1.658; 95% CI 1.074 to 2.560) and concomitant facial bone fractures of the maxilla (OR 1.625; 95% CI 1.111 to 2.377) and zygoma (OR 1.670; 95% CI 1.126 to 2.475). CONCLUSIONS Elderly patients were vulnerable to facial trauma, and concurrent facial bone fracture associated with OWF was more commonly observed in this age group. Therefore, a high index of suspicion and thorough investigation, including CT, for OWF-associated facial bone fractures are important.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-June Park
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Jin Yang
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Soo Lim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Kang H, Takahashi Y, Kakizaki H. Isolated orbital floor fracture lateral to infraorbital nerve: report of 2 pediatric patients. Can J Ophthalmol 2015; 50:e121-2. [DOI: 10.1016/j.jcjo.2015.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/30/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
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Heggie AA, Vujcich NJ, Shand JM, Bordbar P. Isolated orbital floor fractures in the paediatric patient: case series and review of management. Int J Oral Maxillofac Surg 2015; 44:1250-4. [PMID: 26022513 DOI: 10.1016/j.ijom.2015.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
Orbital injuries warranting surgical intervention are infrequent in the paediatric population, but 'blowout, trap door' fractures are unique in children and may constitute a relative surgical emergency. A retrospective review of isolated orbital floor fractures at the Royal Children's Hospital of Melbourne over a 10-year period was undertaken to evaluate the outcome of those patients who required surgical exploration. Twenty-two patients with documented isolated orbital floor injuries were studied. Preoperative signs and symptoms including diplopia, ocular motility, paresthesia, enophthalmos, hypoglobus, and the presence of nausea and vomiting were recorded. Thirteen patients underwent non-surgical management and nine patients underwent surgical exploration of the orbital floor via a trans-subconjunctival approach to reduce any entrapped soft tissue. Postoperative follow-up of these patients varied between 1 month and 18 months and none had any visual disturbance or diplopia in central gaze; however, two patients experienced diplopia in upward gaze at follow-up, although this did not impair the quality of life. Due to the risk of permanent soft tissue damage from the entrapment of the periorbita with or without extraocular muscle tissue, it is recommended that exploration be undertaken as soon as possible to minimize the risk of persistent diplopia due to impaired ocular motility.
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Affiliation(s)
- A A Heggie
- Oral and Maxillofacial Surgery, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Melbourne, Australia.
| | - N J Vujcich
- Oral and Maxillofacial Surgery, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Melbourne, Australia
| | - J M Shand
- Oral and Maxillofacial Surgery, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Melbourne, Australia
| | - P Bordbar
- Oral and Maxillofacial Surgery, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Melbourne, Australia
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Su Y, Shen Q, Lin M, Fan X. Diplopia of pediatric orbital blowout fractures: a retrospective study of 83 patients classified by age groups. Medicine (Baltimore) 2015; 94:e477. [PMID: 25634197 PMCID: PMC4602978 DOI: 10.1097/md.0000000000000477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Orbital blowout fractures are relatively rare in patients under 18 years of age, but may lead to serious complications. We conducted this retrospective study to evaluate diplopia, clinical characteristics, and postoperative results in cases of orbital blowout fractures in the pediatric population. Eighty-three patients, all less than 18 years old, with orbital blowout fractures, were divided into 3 groups by age: 0 to 6 years old, 7 to 12 years old, and 13 to 18 years old. The cause of injury, fracture locations, diplopia grades, ocular motility restrictions, enophthalmos, and postoperative results were reviewed from their records. Chi-square tests, Fisher's exact analyses, analyses of variance, and logistic regressions were performed to determine characteristics associated with diplopia, and to identify factors related to residual diplopia in pediatric patients. The most common causes of injuries were traffic accidents in the 0 to 6 years old group, normal daily activities in the 7 to 12 years old group, and assaults in the 13 to 18 years old group. Floor fractures were the most common location in both the 0 to 6- and 7 to 12 years old groups, and medial-floor fractures were the most common location in the 13 to 18 years old group. The occurrence of preoperative diplopia was related to ocular motility restriction and enophthalmos, but not with the age group, the gender, the cause of injury, or the fracture locations. The time interval from injury to surgery was significant in the outcome of postoperative diplopia (P < 0.01). A statistical difference was also found in the recovery time from diplopia among the 3 age groups (P < 0.01). The characteristics of orbital blowout fracture varied among the different age groups. It was related to 2 factors, the cause of injury and fracture locations, which probably resulted from structural growth changes and differences in daily habits. Children had a slower recovery from orbital fractures, and the younger the patient, the longer it took for recovery from diplopia after surgery.
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Affiliation(s)
- Yun Su
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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