Growing fracture of the orbital roof

Growing fractures rarely arise in the skull base, and their pathogenesis and treatment are still debated. The clinical and radiologic findings of a growing fracture involving the orbital roof in a 5-year-old boy are presented and the relevant literature is reviewed. The clinical picture of growing fracture of the orbital roof is dominated by ocular symptoms such as diplopia, eyelid swelling, and displaced eye globe. Computed tomography scan is excellent for demonstrating the bony defect in the orbital roof while magnetic resonance imaging is more sensitive in showing the intraorbital extension of the leptomeningeal cyst. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Craniotomy with direct repair of the dural and bone defects is the treatment of choice. Growing fracture of the orbital roof may complicate minor head injury and should be considered in the differentiated diagnosis in cases of persistent ocular symptoms.