Internal orbital fractures in the pediatric age group: Characterization and management

Abstract

Objective To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population. Design Retrospective observational case series. Participants: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital (“blowout”) fractures. Methods Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. Main outcome measures Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications. Results Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group. Conclusions Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.