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Basnet A, Chug A, Simre S, Vyas A, Shrestha S. Comprehensive Management of Pediatric Orbital Fractures: A Case Series and Review of Literature. Cureus 2024; 16:e57915. [PMID: 38725748 PMCID: PMC11081518 DOI: 10.7759/cureus.57915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.
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Affiliation(s)
- Abiskar Basnet
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Dehradun, IND
| | - Ashi Chug
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Saurabh Simre
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Akansha Vyas
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, IND
| | - Sudarshan Shrestha
- Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Hsieh PJ, Liao HT. Outcome Analysis of Surgical Timing in Pediatric Orbital Trapdoor Fracture with Different Entrapment Contents: A Retrospective Study. CHILDREN 2022; 9:children9030398. [PMID: 35327770 PMCID: PMC8947637 DOI: 10.3390/children9030398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Orbital trapdoor fracture occurs more commonly in pediatric patients, and previous studies suggested early intervention for a better outcome. However, there is no consensus on the appropriate timing of emergent intervention due to the insufficient cases reported. In the current retrospective study, we compared the outcomes of patient groups with different time intervals from injury to surgical intervention and entrapment content. Twenty-three patients who underwent surgery for trapdoor fracture between January 2001 and September 2018 at Chang Gung Memorial Hospital were enrolled. There was no significant difference in diplopia and extraocular muscle (EOM) movement recovery rate in patients who underwent surgery within three days and those over three days. However, among the patients with an interval to surgery of over three days, those with muscle entrapment required a longer period of time to recover from EOM movement restriction (p = 0.03) and diplopia (p = 0.03) than those with soft tissue entrapment. Regardless of time interval to surgery, patients with muscle entrapment took longer time to recover from EOM movement restriction (p = 0.036) and diplopia (p = 0.042) and had the trend of a worse EOM recovery rate compared to patients with soft tissue entrapment. Hence, we suggested that orbital trapdoor fractures with rectus muscle entrapment should be promptly managed for faster recovery.
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Affiliation(s)
- Pei-Ju Hsieh
- Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital at LinKou, Chang Gung University College of Medicine, Taoyuan City 333, Taiwan;
| | - Han-Tsung Liao
- Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital at LinKou, Chang Gung University College of Medicine, Taoyuan City 333, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen 361000, China
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2946); Fax: +886-3-328-9582
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Yu J, Zhang J, Chen S, Han Q, Yan H. Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:463. [PMID: 33850860 PMCID: PMC8039696 DOI: 10.21037/atm-21-598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Compared to isolated orbital wall fracture, combined orbital floor and medial wall fractures are more likely to be required surgical correction due to a higher possibility of complications. However, it remains a challenge to repair concomitant orbital fracture using a one-piece implant due to the complex anatomic structures of the orbit. Aiming to reduce surgical difficulties and enhance therapeutic effects, we repaired unilateral combined orbital floor and medial wall fractures using two separated modified titanium mesh plates in this study. Methods A retrospective study was conducted on 21 consecutive patients who presented with unilateral combined orbital floor and medial wall fractures in Tianjin Medical University General Hospital between November 2010 and January 2016. The orbital fractures were repaired with two separated titanium mesh plates. The corner at the transition zone area between the orbital floor and the medial wall was reconstructed simultaneously through a combined transcaruncular and inferior subciliary approach with lateral canthotomy. The pre- and post-operative functions and aesthetic results were evaluated. Results Preoperatively, all patients presented with 3.5-6.5 mm enophthalmos, five patients presented with diplopia with ocular motility limitation in injured eyes, and six patients presented with hypoglobus ranging from 1.5 to 3.5 mm. Orbital floor and medial wall fractures of all patients were successfully repaired with two separated titanium mesh plates. Postoperatively, enophthalmos was improved in all patients, which was less than 2 mm on the last follow-up day. Hypoglobus was disappeared in all six patients postoperatively. Diplopia was resolved in five patients within 3 months post operation, and was reduced in one patient. Conclusions In cases of unilateral concomitant orbital floor and medial wall fractures, two titanium mesh plates implantation is a safe and effective procedure. It is worthwhile to take the technique into account when the key points to consider when applying this method include reconstruction of the special orbital shape and the complete return reposition of prolapsed intraorbital soft tissues were intended.
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Affiliation(s)
- Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingkai Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Han
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-repair, and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
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Abstract
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
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Affiliation(s)
- Kirkland N Lozada
- Department of Otolaryngology Head & Neck Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Patrick W Cleveland
- Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jesse E Smith
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Su Y, Shen Q, Bi X, Lin M, Fan X. Delayed surgical treatment of orbital trapdoor fracture in paediatric patients. Br J Ophthalmol 2018; 103:523-526. [PMID: 29858184 DOI: 10.1136/bjophthalmol-2018-311954] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/14/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Trapdoor fracture is a special type of orbital blowout fracture. Although early surgery is recommended, there still remain some patients delayed by various reasons. In this study, we analysed the clinical characteristics of delayed paediatric patients, especially those with different levels of ocular motility restriction before surgery. METHODS Thirty patients (3 to 14 years old) who underwent delayed surgery for trapdoor fractures between January 2008 and September 2016 were enrolled. Their demographics, causes of injury and delay, clinical features, imaging data and follow-up information were collected. RESULTS Muscular entrapment was found in 17 patients (group A) and soft-tissue entrapment in 13 patients (group B). 12 (7 in group A) presented with severe motility restriction and 18 (10 in group A) with mild restriction before surgery. 41.7% with severe restriction recovered after surgery, compared with 83.3% with mild restriction. Four (23.7%) in group A (all with severe restriction) and six (46.2%) in group B (half with severe restriction) presented with persistent diplopia. CONCLUSIONS Long recovery time and a high percentage of persistent diplopia are the main problems of delayed trapdoor fracture in children. A prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment even if an urgent treatment is hard to achieve. So are patients with soft-tissue entrapment and significant motility restriction. In the other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery right after diagnosis is still preferable regardless of the entrapped contents.
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Affiliation(s)
- Yun Su
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qin Shen
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiaoping Bi
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ming Lin
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Abstract
There are few reports of blowout fractures of the orbital floor in children younger than 5 years of age; in a search of the literature, we found only six reported cases which revealed the exact age, correct diagnosis, and treatment. We herein report the case of a 3-year-old boy with a blowout fracture of the orbital floor. Computed tomography showed a pure blowout fracture of the left orbital floor with a slight dislocation of the orbital contents. The patient was treated conservatively due to the absence of abnormal limitation of eye movement or enophthalmos. The patient did not develop any complications that necessitated later surgical intervention. Computed tomography at 6 months after the injury showed the regeneration of the orbital floor in the area of the fracture and no abnormalities in the left maxillary sinus. We herein present our case and the details of six other cases reported in the literature, and discuss their etiology, diagnosis, and treatment methods.
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Affiliation(s)
- Akira Sugamata
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Naoki Yoshizawa
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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