Orbital fractures in children: A review of outcomes

Abstract The third most common facial fractures in children are fractures of the orbit, and the medial wall and floor are the commonest sites affected. The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardi...

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Veröffentlicht in:British journal of oral & maxillofacial surgery 2013-12, Vol.51 (8), p.789-793
Hauptverfasser: Gerber, Barbara, Kiwanuka, Paul, Dhariwal, Daljit
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container_title British journal of oral & maxillofacial surgery
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creator Gerber, Barbara
Kiwanuka, Paul
Dhariwal, Daljit
description Abstract The third most common facial fractures in children are fractures of the orbit, and the medial wall and floor are the commonest sites affected. The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005–2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia ( n = 6/11) and restricted eye movement ( n = 3/11) were associated with trapdoor injury, while enophthalmos ( n = 1/9) and paraesthesia ( n = 3/9) were related to open blow-out fractures. To reduce compromised outcomes, prompt operation is warranted in all children with fractures of the orbital floor regardless of the configuration.
doi_str_mv 10.1016/j.bjoms.2013.05.009
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The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005–2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia ( n = 6/11) and restricted eye movement ( n = 3/11) were associated with trapdoor injury, while enophthalmos ( n = 1/9) and paraesthesia ( n = 3/9) were related to open blow-out fractures. 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The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005–2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia ( n = 6/11) and restricted eye movement ( n = 3/11) were associated with trapdoor injury, while enophthalmos ( n = 1/9) and paraesthesia ( n = 3/9) were related to open blow-out fractures. To reduce compromised outcomes, prompt operation is warranted in all children with fractures of the orbital floor regardless of the configuration.</description><subject>Accidental Falls</subject><subject>Adolescent</subject><subject>Athletic Injuries - surgery</subject><subject>Child</subject><subject>Dentistry</subject><subject>Diplopia - etiology</subject><subject>Enophthalmos - etiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fracture</subject><subject>Fractures, Open - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Nausea - etiology</subject><subject>Ocular Motility Disorders - etiology</subject><subject>Orbital</subject><subject>Orbital Fractures - classification</subject><subject>Orbital Fractures - surgery</subject><subject>Outcomes</subject><subject>Paediatric</subject><subject>Paresthesia - etiology</subject><subject>Postoperative Complications</subject><subject>Reflex, Oculocardiac - physiology</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Vomiting - etiology</subject><issn>0266-4356</issn><issn>1532-1940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1r1UAUhgex2GvbXyBIlm4Sz5mvZASFUqwWCl2o62EyOcGJSabOJJX-e3N7q4tuujqb94PzvIy9QagQUL8fqnaIU644oKhAVQDmBduhErxEI-El2wHXupRC6WP2OucBABRH9Yodc2FQSSN2TNykNixuLPrk_LImykWYC_8zjF2i-UNxXiS6C_SniH0R18XHifIpO-rdmOns8Z6wH5efv198La9vvlxdnF-XXqJcytoZar3oNWmohTR1641T2oEC7JrGOayFbmqJgnTPRd1B3TRkOqS2l61qxAl7d8i9TfH3SnmxU8iextHNFNdsUWoutOESNqk4SH2KOSfq7W0Kk0v3FsHuadnBPtCye1oWlN1oba63jwVrO1H33_MPzyb4eBDQ9uaGIdnsA82eupDIL7aL4ZmCT0_8fgxz8G78RfeUh7imeSNo0WZuwX7bD7bfCwVskVqLv4Cwjy4</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Gerber, Barbara</creator><creator>Kiwanuka, Paul</creator><creator>Dhariwal, Daljit</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131201</creationdate><title>Orbital fractures in children: A review of outcomes</title><author>Gerber, Barbara ; Kiwanuka, Paul ; Dhariwal, Daljit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-7a9ebc3f6e6073497bc9a56a0501d88aa173687413e6f237d0788e9d1ebf4b583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Accidental Falls</topic><topic>Adolescent</topic><topic>Athletic Injuries - surgery</topic><topic>Child</topic><topic>Dentistry</topic><topic>Diplopia - etiology</topic><topic>Enophthalmos - etiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fracture</topic><topic>Fractures, Open - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Nausea - etiology</topic><topic>Ocular Motility Disorders - etiology</topic><topic>Orbital</topic><topic>Orbital Fractures - classification</topic><topic>Orbital Fractures - surgery</topic><topic>Outcomes</topic><topic>Paediatric</topic><topic>Paresthesia - etiology</topic><topic>Postoperative Complications</topic><topic>Reflex, Oculocardiac - physiology</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Vomiting - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gerber, Barbara</creatorcontrib><creatorcontrib>Kiwanuka, Paul</creatorcontrib><creatorcontrib>Dhariwal, Daljit</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of oral &amp; maxillofacial surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gerber, Barbara</au><au>Kiwanuka, Paul</au><au>Dhariwal, Daljit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Orbital fractures in children: A review of outcomes</atitle><jtitle>British journal of oral &amp; maxillofacial surgery</jtitle><addtitle>Br J Oral Maxillofac Surg</addtitle><date>2013-12-01</date><risdate>2013</risdate><volume>51</volume><issue>8</issue><spage>789</spage><epage>793</epage><pages>789-793</pages><issn>0266-4356</issn><eissn>1532-1940</eissn><abstract>Abstract The third most common facial fractures in children are fractures of the orbit, and the medial wall and floor are the commonest sites affected. The aetiology, clinical presentation, and timing of operation all differ from those of adults. If there are few or no clinical signs, but oculocardiac reflex is present, it is highly suggestive of trapdoor injury. This retrospective study includes all consecutive children (younger than 18 years) referred with confirmed fractures of the orbital floor over a 5-year period (2005–2010). A total of 24 patients were identified with a mean age of 13.5 years, and most injuries were secondary to falls. Isolated injury to the orbital floor occurred in 14 (58%); the rest involved other fractures of the orbital wall or face, or both. There were 11 trapdoor fractures (46%), and 9 open blow-out fractures (38%). Overall, nausea and vomiting occurred in 13 patients (54%); 8 of these had trapdoor fractures. Most patients had operations (22, 92%), and the mean time to operation was 4 days. Complications increased with delays to theatre. Those operated on within 1 day had fewer complications than those who had operations after 3 days. Postoperatively, diplopia ( n = 6/11) and restricted eye movement ( n = 3/11) were associated with trapdoor injury, while enophthalmos ( n = 1/9) and paraesthesia ( n = 3/9) were related to open blow-out fractures. To reduce compromised outcomes, prompt operation is warranted in all children with fractures of the orbital floor regardless of the configuration.</abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>23915493</pmid><doi>10.1016/j.bjoms.2013.05.009</doi><tpages>5</tpages></addata></record>
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subjects Accidental Falls
Adolescent
Athletic Injuries - surgery
Child
Dentistry
Diplopia - etiology
Enophthalmos - etiology
Female
Follow-Up Studies
Fracture
Fractures, Open - surgery
Humans
Male
Nausea - etiology
Ocular Motility Disorders - etiology
Orbital
Orbital Fractures - classification
Orbital Fractures - surgery
Outcomes
Paediatric
Paresthesia - etiology
Postoperative Complications
Reflex, Oculocardiac - physiology
Retrospective Studies
Surgery
Time Factors
Tomography, X-Ray Computed - methods
Treatment Outcome
Vomiting - etiology
title Orbital fractures in children: A review of outcomes
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