Abstract
ObjectivesTo investigate the factors affecting recovery of diplopia and limited ocular motility in pediatric patients who underwent surgery for orbital wall fracture.DesignRetrospective observational case series.MethodsIn this retrospective observational case series, 150 pediatric patients (1–18 years old) who were diagnosed with orbital medial wall or floor fracture and underwent corrective surgery between 2004 and 2016 at Seoul National University Bundang Hospital were included. The medical records of patients with orbital medial wall or floor fracture were reviewed, including sex, age, diplopia, ocular motility, preoperative computed tomographic finding, and surgical outcomes. Factors affecting recovery of diplopia and ocular motility limitation were analyzed.ResultsOf the 150 patients (134 boys; mean age, 14.4 years) who underwent corrective surgery for orbital wall fracture, preoperative binocular diplopia was found in 76 (50.7%) patients and limited ocular motility in 81 (54.0%). Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia. In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution. Multivariate analysis revealed supraduction limitation (Hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.19–2.55), larger horizontal orbital floor defects (HR = 1.22, 95% CI = 1.07–1.38), and shorter time interval to first visit (HR = 0.73) as negative prognostic factors for the recovery of diplopia. In addition, muscle incarceration (HR = 3.53, 95% CI = 1.54–8.07) and retrobulbar hemorrhage (HR = 3.77, 95% CI = 1.45–9.82) were found as negative prognostic factors for the recovery of motility limitation.ConclusionsPresence of muscle incarceration and retrobulbar hemorrhage, horizontal length of floor fracture, supraduction limitation, and time interval from trauma to first visit were correlated with the surgical outcomes in pediatric orbital wall fracture patients. These results strengthen that the soft tissue damage associated with bony fracture affects the orbital functional unit. When managing children with orbital wall fracture, meticulous physical examination and thorough preoperative computed tomography based evaluation will help physicians to identify damage of orbital functional unit.
Highlights
Orbital wall fractures are common results of periorbital blunt trauma [1]
Presence of muscle incarceration or severe supraduction limitation delayed the recovery of diplopia
In case of ocular motility limitation, presence of muscle incarceration and retrobulbar hemorrhage were related with the delayed resolution
Summary
Orbital wall fractures are common results of periorbital blunt trauma [1]. In the pediatric population, the common presenting symptoms are quite different from adults because fractures with tissue incarceration are more common due to their bony elasticity [2,3,4]. Incarcerated orbital tissues frequently cause limited ocular motility and subsequent diplopia [5, 6], and in pediatric patients, these symptoms can be persistent even after relevant surgery [6, 7]. There had been studies reporting factors affecting surgical outcomes in adult orbital wall fracture patients [8]. To the best of our knowledge, other than a few small case series [6, 9,10,11], the prognostic factors of surgical outcome in pediatric orbital wall fractures has not been evaluated in a large scale. We investigated diplopia and limitation of ocular motility in pediatric orbital wall fracture and analyzed the factors associated with surgical outcomes of pediatric orbital wall fracture
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