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Oral and Maxillofacial Surgery

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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

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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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
Keywords: Diplopia
Facial Fracture
Facial Fracture
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

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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