Outcome Analysis of Surgical Timing in Pediatric Orbital Trapdoor Fracture with Different Entrapment Contents: A Retrospective Study.

Pei-Ju Hsieh,Han-Tsung Liao

doi:10.3390/children9030398

Abstract

Orbital trapdoor fracture occurs more commonly in pediatric patients, and previous studies suggested early intervention for a better outcome. However, there is no consensus on the appropriate timing of emergent intervention due to the insufficient cases reported. In the current retrospective study, we compared the outcomes of patient groups with different time intervals from injury to surgical intervention and entrapment content. Twenty-three patients who underwent surgery for trapdoor fracture between January 2001 and September 2018 at Chang Gung Memorial Hospital were enrolled. There was no significant difference in diplopia and extraocular muscle (EOM) movement recovery rate in patients who underwent surgery within three days and those over three days. However, among the patients with an interval to surgery of over three days, those with muscle entrapment required a longer period of time to recover from EOM movement restriction (p = 0.03) and diplopia (p = 0.03) than those with soft tissue entrapment. Regardless of time interval to surgery, patients with muscle entrapment took longer time to recover from EOM movement restriction (p = 0.036) and diplopia (p = 0.042) and had the trend of a worse EOM recovery rate compared to patients with soft tissue entrapment. Hence, we suggested that orbital trapdoor fractures with rectus muscle entrapment should be promptly managed for faster recovery.

Highlights

Not every patient fully recovers from extraocular muscle (EOM) movement restriction and diplopia after the operation
There was no significant difference in the recovery rate in EOM movement restriction and diplopia between the two types of entrapment content, but the subgroup with muscle entrapment took significantly longer to recover from both EOM
The trends of worse recovery rate and longer recovery time from EOM movement restriction and diplopia were found, there were no significant differences between subgroups in both types of entrapment content (Table 6)

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Orbital trapdoor fracture occurs more frequently in patient under 18 years old. Due to the inherent elasticity of facial bone, the displaced orbital wall recoils back and traps the soft tissue or rectus muscle, causing extraocular muscle (EOM) movement restriction and diplopia. The injury may induce oculocardiac reflex by traction on EOM, causing bradycardia, nausea, and syncope [1]. To remove these acute symptoms, releasing the entrapment content is significantly effective. Not every patient fully recovers from EOM movement restriction and diplopia after the operation. The mechanism remains unclear, but most authors have agreed that the entrapment induces muscle incarceration and causes irreversible muscle fibrosis [2–5]

Results

Discussion

Conclusion