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Published in: Oral and Maxillofacial Surgery 2/2023

21-03-2022 | Diplopia | Original Article

Isolated paediatric orbital fractures: a case series and review of management at a major trauma centre in the UK

Authors: Patrick Harrison, Safiya Hafeji, Alexandra O. Green, Anthony D. Chellappah, Kathleen Fan

Published in: Oral and Maxillofacial Surgery | Issue 2/2023

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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.
Literature
1.
go back to reference Gassner R, Tarkan T, Hachl O et al (2004) Craniomaxillofacial trauma. In children: A review of 3, 385 cases with 6, 6060 injuries in 10 years. J Oral Maxillofac Surg 62:399-407 n.dCrossRefPubMed Gassner R, Tarkan T, Hachl O et al (2004) Craniomaxillofacial trauma. In children: A review of 3, 385 cases with 6, 6060 injuries in 10 years. J Oral Maxillofac Surg 62:399-407 n.dCrossRefPubMed
2.
go back to reference Kidd A, Beattie T, Campbell-Hewson G (2010) Facial injury patterns in a UK paediatric population aged under 13 years. Emerg Med J 27:603–6 n.dCrossRefPubMed Kidd A, Beattie T, Campbell-Hewson G (2010) Facial injury patterns in a UK paediatric population aged under 13 years. Emerg Med J 27:603–6 n.dCrossRefPubMed
3.
go back to reference Kaban LB (1993) Diagnosis and treatment of fractures of the facial bones in children 1943–1993. J Oral Maxillofac Surg 51:722–9 n.dCrossRefPubMed Kaban LB (1993) Diagnosis and treatment of fractures of the facial bones in children 1943–1993. J Oral Maxillofac Surg 51:722–9 n.dCrossRefPubMed
5.
go back to reference Vujcich N, Gebauer D (2018) Current and evolving trends in the management of facial fractures. Aust Dent J 63:S35-S47 n.dCrossRefPubMed Vujcich N, Gebauer D (2018) Current and evolving trends in the management of facial fractures. Aust Dent J 63:S35-S47 n.dCrossRefPubMed
6.
go back to reference Dubois L, Steenan S, Gooris P et al (2015) Controversies in orbital reconstruction. I—Defect driven orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg 44:308–15 n.dCrossRefPubMed Dubois L, Steenan S, Gooris P et al (2015) Controversies in orbital reconstruction. I—Defect driven orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg 44:308–15 n.dCrossRefPubMed
7.
go back to reference Dubois L, Steenan S, Gooris P et al (2015) Controversies in orbital reconstruction. II—Timing of post-traumatic orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg 44:433–40 n.dCrossRefPubMed Dubois L, Steenan S, Gooris P et al (2015) Controversies in orbital reconstruction. II—Timing of post-traumatic orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg 44:433–40 n.dCrossRefPubMed
8.
go back to reference Dubois L, Steenan S, Gooris P et al (2016) Controversies in orbital reconstruction. III—Biomaterials for orbital reconstruction: a review with clinical recommendations. Int J Oral Maxillofac Surg 45:41-50 n.dCrossRefPubMed Dubois L, Steenan S, Gooris P et al (2016) Controversies in orbital reconstruction. III—Biomaterials for orbital reconstruction: a review with clinical recommendations. Int J Oral Maxillofac Surg 45:41-50 n.dCrossRefPubMed
13.
go back to reference Office for national statistics (2019) English indices of deprivation 2019. London, n.d Office for national statistics (2019) English indices of deprivation 2019. London, n.d
19.
go back to reference Sires BS, Stanley RB, Levine LM (1960) Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol Chic Ill 1998(116):955–956 Sires BS, Stanley RB, Levine LM (1960) Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol Chic Ill 1998(116):955–956
25.
go back to reference Hatton MP, Watkins LM, Rubin PAD (2001) Orbital fractures in children. Ophthal Plast Reconstr Surg 17 Hatton MP, Watkins LM, Rubin PAD (2001) Orbital fractures in children. Ophthal Plast Reconstr Surg 17
Metadata
Title
Isolated paediatric orbital fractures: a case series and review of management at a major trauma centre in the UK
Authors
Patrick Harrison
Safiya Hafeji
Alexandra O. Green
Anthony D. Chellappah
Kathleen Fan
Publication date
21-03-2022
Publisher
Springer Berlin Heidelberg
Published in
Oral and Maxillofacial Surgery / Issue 2/2023
Print ISSN: 1865-1550
Electronic ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-022-01056-z

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