Orbital Wall Fracture Research Articles

Alcohol Intoxication-Related Soft Tissue Injuries in Patients With Orbital Wall Fractures

To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting. A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups. In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia. In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.

Causes and Surgical Outcome of Orbital Wall Fractures in Mongolia

Objective: To determine causes, clinical manifestations of orbital wall blowout fractures, and evaluate surgical outcomes. Methods: A retrospective study with repeated measurements was conducted in 194 cases with orbital reconstructive surgery between 2002 and 2017 at Orbita Eye Hospital. The analyzed variables were patient age, sex, causes, and clinical manifestation of orbital wall fractures. Surgical outcomes, implant dependent, and surgical approach complications were prospectively analyzed in 60 patients up to 24 months after the initial surgery. Results: Orbital wall fractures were caused by assault in 82.7% of cases, household accidents 9.9%, car accidents 7.4%, and 0% by a sports injury. Diplopia was noted in 16.7%, extraocular movement limitation in 16.7%, enophthalmos in 23.3% for 24 months, or and more following surgery. In 4.2% of cases, prolapse of the orbital fat was noted using the transconjunctival approach, and 16.6% eyelid retraction with scarring in the subciliary approach. Implant displacement was noted 6.6% of cases in which a silicone sheet was used to reconstruct the fracture defect. Conclusions: Assault was the leading cause of orbital fractures, and this most often occurred in young males in Mongolia. Common signs and symptoms of orbital fractures were enophthalmos, diplopia, and extraocular movement limitation. The range of post-surgical enophthalmos, diplopia, and implant-related complications was consistent with those reported by other studies.

Symptomatic cystic lesions as late post-operative complications of silicone implantation for orbital wall fracture reconstruction: A long-term follow-up study

Although complications of silicone implants and development of new materials have led to a decline in the use of silicone implants for orbital wall fractures, their advantages are still reported. The overall incidence, risk factor and treatment of silicone implant complications, especially those caused by cystic lesions, remain unclear. We aimed to report our experiences of patients with orbital wall fractures that were reconstructed with silicone implants and followed up for a long period. We retrospectively analysed 56 patients who underwent surgical repair of the orbital wall fractures with a silicone implant from January 2006 to December 2017 and were followed up for more than 6 months. A chart review and the assessment of demographic and surgical factors, among others, were performed. There were 47 eligible patients in this study, and the mean post-operative follow-up period was 83.1 months. When comparing the results obtained 6 months post-operatively with those obtained at the final follow-up, the overall complication rate increased from 5/47 to 13/47, and the silicone implant removal rate increased from 0/47 to 10/47. The symptoms caused by the cystic lesions were managed through silicone implant removal. The immediate post-operative bleeding was significantly associated with silicone implant survival (p = 0.008). Silicone implants used for orbital wall fractures were never stabilised during the long-term study. Much attention should be paid during the follow-up of high-risk patients. Most late complications were caused by cystic lesions, and only silicone implant removal would be sufficient and considered safe as the initial intervention.

Orbital roof fractures as an indicator for concomitant ocular injury.

Orbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. This study aims to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared with non-roof involving orbital wall fractures. This study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016. Orbital wall fractures were categorized as roof involving (N = 50) and non-roof involving (N = 290). Comparisons were made between these two groups to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation. Assault (40.7%) was the most common cause of non-roof-involving fractures while falls from height (20.0%) were associated with a higher rate of roof fractures. Roof-involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%), lid lacerations (23.4%), and traumatic optic neuropathy (10.4%). A reliable subjective exam on initial ophthalmic consultation was not achieved in a larger proportion of roof fracture patients (30%). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis. Concomitant ocular injury is common in roof-involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof-involving orbital wall fractures.

A novel technique for placing titanium mesh with porous polyethylene via the endoscopic transnasal approach into the orbit for medial orbital wall fractures.

BackgroundThe endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach.MethodsFourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated.ResultsPostoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications.ConclusionsWe obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

Meibomian Gland Dysfunction in Patients Who Underwent Transconjunctival Approach Surgery for Inferior Orbital Wall Fractures.

To investigate whether transconjunctival approach surgery caused meibomian gland dysfunction in patients with inferior orbital wall fractures. Twenty consecutive patients who underwent reconstruction surgery for unilateral inferior orbital wall fracture via a transconjunctival approach were enrolled in this study. All patients were asked to complete the Ocular Surface Disease Index questionnaire for each separate eyelid. Both eyelids of each patient underwent slit lamp examination to determine the lid margin abnormality scores. The structure of the meibomian gland was assessed using meibography. Intraindividual comparison of outcome measurements between both eyelids was performed using the Wilcoxon signed-rank test. The contralateral eyelid of each patient was used as a normal control. The mean Ocular Surface Disease Index score of the operated eyelid was 46.5 ± 8.9, which was significantly higher than that of the contralateral normal eyelid (23.4 ± 7.3; P = 0.02). The lid margin abnormality score of the operated eyelid (1.2 ± 0.7) was higher than that of the normal eyelid (0.5 ± 0.7; P = 0.033). The meibography score of the eyelid on the operated side (1.8 ± 0.8) was greater than that of the contralateral eyelid (1.0 ± 1.0; P = 0.015). Compared to paired normal eyelids, eyelids that underwent transconjunctival approach surgery exhibited significant signs of meibomian gland dysfunction. Clinicians should be aware of such ocular symptoms in patients after transconjunctival approach surgery.

ЭПИДЕМИОЛОГИЯ ПЕРЕЛОМОВ СТЕНОК ОРБИТ. РЕТРОСПЕКТИВНОЕ ИССЛЕДОВАНИЕ

Midfacial fractures are presented by wide range of different patterns and severity. Orbital walls fractures have a special place in the structure of traumatic craniofacial injuries. Referring foreign authors, fractures of external rims and internal orbital walls are presented in more than 40 % of all bony injuries of facial skeleton. And referring Russian authors frequency of zygomaticomaxillary complex and isolated maxillary fractures presented by 12 and 8 % respectively. Furthermore complex anatomy of the orbit and proximity of the globe can occur some difficulties in diagnostics and treatment process of these patients. Today there are two main mechanisms of orbital walls fractures development – Blow-out, when fracture caused by increasing of intraorbital pressure, and Force-transmission, when force applied to external orbital rims transmits to a weaker orbital walls. Moreover in young patients Trapdoor mechanism is actual, which results in entrapment of soft tissues in the fracture line. Often there is an inferior rectus muscle entrapment and that is serious complication, when immediate surgery is required.
 The article deals with issues of anatomical construction of orbit and orbital trauma epidemiology based on statistics of neurosurgical department of Central city clinical hospital № 23, Yekaterinburg, for 2017.

Tension pneumo-orbit secondary to minor blunt force trauma

IntroductionTension pneumo-orbit is a rare but eye-threatening sequelae of orbital trauma. Minimal trauma to the lamina papyracea can result in a valve effect leading to rapid-onset proptosis and optic nerve compression in the absence of a haematoma. Case reportWe describe a case of medial orbital wall fracture in a 35-year-old lady following a minor fall at home. She presented with severe proptosis of the left eye. Imaging showed marked pneumo-orbit, which was managed definitively by endoscopic orbital decompression. DiscussionTension pneumo-orbit requires prompt recognition and surgical decompression. An endonasal approach may be used to decompress the orbit via the medial wall.

Evaluation of Surgical-Navigation System in Management of Orbital Disorders

AbstractBackground: Surgical navigation guidance is primarily designed to assist with surgery on bony tissues and closed spaces, it is widely used in neurosurgery and sinus surgery. And since the limited mobility of the soft tissues of the orbit, as they are tightly contained within its bony walls, stereotactic navigation may be a useful tool in orbial surgeries such as tumor excisions, biopsies, orbital wall fractures, and orbital decopmression.Aim of Study: To evaluate whether the use of Frameless surgical navigation is useful and time efficient in removing orbital masses and repairing orbital wall fracture as known to be a helpful tool in Neurosurgery and sinus surgery.Patients and Methods: Prospective interventional non-controlled non-randomized case series study was coducted in Cairo Univeristy Hospitals from June 2013 to December 2014 on 15 patients with primary or recurrent post-septal orbital pathology using the Electromagnetic “FusionTM ENT Naviga-tion System” during the surgery. Primary outcomes were assessing time efficiency through operative times (Total Time, Operating Time and Maintenance Time), extent of mass excision and fracture repair. Secondary outcomes were im-provement in Hertel's readings and detecting complication related to the navigation system.Results: The mean of maintenance time percentage com-pared to the total operating time was 46.7% with SD ±6.1 that lead to relatively longer total operating time, but as more cases were performed, it decreased gradually. Complete excision was achieved in 70% of cases. The p-value for improved Hertel's reading was 0.016 and only one case had significant complications.Conclusion: Although promising results were seen in orbital wall fracture and well circumscribed orbital masses. The Surgical Navigation System cannot yet be considered the standard of care for patients with different orbital pathologies as it prolongs the total operating time. However, it is helpful and promising in complicated cases of recurrent and infiltrative masses and massive trauma, where the normal anatomical landmarks are compromised specially with the evolving updates in improving this technology.

Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan.

To evaluate outcomes from all British military patients who underwent eye removal during the Iraq and Afghanistan wars. Retrospective case note review of all patients (n = 19) who had undergone either evisceration or enucleation, on a database of all military patients repatriated to the Royal Centre for Defence Medicine, Birmingham. Twenty eye removals were performed on 19 patients, of which 14 (70%) were eviscerations and 6 (30%) were enucleations. Orbital wall fractures were seen in 12 (61%) patients, with orbital floor fractures being the most common. The eye removal was a primary procedure in fiveof fourteen eviscerations, and fiveof six enucleations. Complications were seen after four (28.6%) eviscerations patients and two (33.3%) enucleations. Postoperative pain was problematic after three (21.4%) eviscerations but no enucleations. Orbital implants were placed during three of the fiveprimary enucleations, with good outcomes in two. One patient however required implant retrieval and wound washout due to a high risk of infection and communication with the intra-cranial space. Evisceration and enucleation are both viable options in the management of severe ocular trauma in military patients. Evisceration and enucleation have similar complication rates and outcomes, and both have low rates of sympathetic ophthalmia. Primary orbital implants can be at high risk in cases with orbital roof fracture, but can provide good outcomes in select patients.

Accelerated Return to Play for Professional Rugby Players After Facial Fractures.

Facial fractures may result in a significant time away from competition for professional rugby players. An understanding of the return-to-play times is an integral part of clinical decision making when treating professional athletes. A period of 8 to 12 weeks has been conventionally recommended for returning to collision sports after facial fractures. The conventional time to return to sports of 8 to 12 weeks is usually too long for professional players. However, the time of return to play after such facial fractures in elite athletes has not been well described. To investigate the return to play after facial fractures in professional rugby players with an accelerated rehabilitation protocol. Ten professional rugby players with facial fractures were identified and analyzed. The authors investigated the number of days required to return to training and full-contact play according to the trauma type. The authors also determined the presence or absence of refractures and sequelae. The average age of the patients was 26.9 years. Medial orbital wall fractures were the most represented pattern, followed by orbital floor fractures and zygomatic arch fractures. The players returned to jogging after 9.9 days, to sports-specific training after a mean of 10.8 days, and to full-contact training after 18.3 days. There were no cases of refractures and sequelae. Players were able to return to their regular rugby activities, earlier than the time commonly allowed to return to full activity.

Опыт лечения пациентов с переломами скулоорбитального комплекса и нижней стенки орбиты

Опыт лечения пациентов с переломами скулоорбитального комплекса и нижней стенки орбиты

A retrospective study of pure medial orbital wall fracture management

To describe the clinical presentation of isolated medial orbital wall fractures, the duration of symptoms and their management. Retrospective study of 60 orbits of 60 patients over 18 years of age with isolated medial wall fractures of the orbit at the facial and trauma center of the Pitié-Salpêtrière university hospital of Paris between June 2012 and November 2015. Diplopia, enophthalmos and limitation of extraocular muscle movements were investigated. The location of the fractures was confirmed with three-dimensional computed tomography. Intraocular trauma was ruled out. Incomplete data were excluded. Eighty-three patients were identified (June 2012-November 2015). Sixty patients (39 males and 21 females) had a complete medical record. The mean age was 37 years, ranging from 18 to 75 years. Assault was the most common cause in 45 patients (75%), followed by sports accidents in 8 patients (13%), motor vehicle accidents in 6 patients (10%), and a fall in 1 patient. On presentation, 51 patients (85%) had no symptoms. Diplopia was present in 9 patients (15%). Four of them (6.7%) had associated enophthalmos. The diplopia resolved spontaneously in 5 patients (5.5%) and persisted more than 2 weeks in 4 patients (6.7%), for whom surgical intervention was recommended. Only 4 patients (6.7%) were managed surgically due to the presence of combined persistent diplopia and enophthalmos. The mean time from trauma to surgery was 18 days (15-45 days). At the 45-day postoperative follow-up, persistent diplopia was present in 1 patient out of the four treated surgically, with no residual enophthalmos. Fifty-six patients were managed conservatively. Asymptomatic fractures do not require surgical repair, and conservative management is adequate. Such fractures heal on their own without any consequences.

A case of pupil dilation recovery after orbital wall fracture

A case of pupil dilation recovery after orbital wall fracture

A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique.

BackgroundTo date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique.MethodsWe had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion.ResultsPostoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion.ConclusionOur ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Application of the three-dimensionally printed biodegradable polycaprolactone (PCL) mesh in repair of orbital wall fractures

PurposeThe present study aims to investigate the surface characteristics and biomechanical properties of 3D-printed polycaprolactone (PCL) mesh and present the clinical outcomes of this implant in the treatment of orbital wall fractures. Patients and methodA retrospective review of patients who underwent surgery for medial, inferior and inferomedial orbital wall fractures using PCL mesh was performed between April 2017 and June 2018. Two clinical outcomes were investigated: functional recovery and anatomical accuracy of reduction detected in image. Furthermore, scanning electron microscopy was used to evaluate the microscopic morphology, surface characteristics, and porosity of the PCL mesh. ResultsAmong a total of 22 patients with a mean age of 41.3 years, the most common cause of injury was assault (54.5%). Fourteen patients (63.6%) had isolated orbital floor fractures. At postoperative 1-week follow-up, three patients (13.6%) exhibited diplopia and a further three patients (13.6%) showed restriction in ocular motility, but these patients had completely recovered by their 6-month postoperative follow-up. Ideal repair of orbital fracture was almost achieved in 21 patients (95.4%) and there were no cases of implant infection, inflammatory response, migration of implant, or hemorrhage. Microscopic imaging of PCL mesh surface revealed fully interconnected micropores with 50% porosity. ConclusionsThe repair of orbital wall fracture using PCL mesh offers reliable stabilization of orbital wall defects with a low complication rate, leading to outstanding functional and aesthetic outcomes. Therefore, PCL mesh is a good alternative for bioresorbable implants in the treatment of orbital wall fractures.

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy.

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.

Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study.

Background/Aim Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). Methods A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. Results Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). Conclusion Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.

Navigation-Assisted Isolated Medial Orbital Wall Fracture Reconstruction Using an U-HA/PLLA Sheet via a Transcaruncular Approach

Purpose: We investigated the feasibility of isolated medial orbital wall fracture reconstruction using an unsintered hydroxyapatite particles/poly L-lactide (u-HA/PLLA) sheet implant with the assistance of intraoperative navigation via the transcaruncular approach. Patients and methods: Ten consecutive patients (5 males and 5 females; mean age, 57.5 years) were included based on the clinical and imaging criteria. All patients underwent surgical treatment of the isolated medial orbital wall fracture using transcaruncular incision and the u-HA/PLLA implant under navigation. The follow-up time was greater than 6 months. Preoperative and postoperative clinical data regarding the presence of diplopia, eye motility restriction, and enophthalmos were assessed. The orbital volumes of the injured and uninjured orbit were also evaluated using computed tomography images. Results: All patients had improved ophthalmologic functional and esthetic outcomes and were successfully treated without any long-term complications arising during follow-up. There was a significant difference between the preoperative and postoperative injured orbits due to herniation of the orbital contents. Moreover, the orbital volume of the postoperative injured side following surgery was the same as that of the unaffected side, indicating that anatomically good reconstruction had been obtained. Conclusions: Surgical treatment using the transcaruncular approach and u-HA/PLLA materials with intraoperative navigation is a safe, promising, and effective technique for isolated medial orbital wall fracture reconstruction.

Management of pediatric orbital wall fractures

ABSTRACTBackgraound: The purpose of this study was to review the clinical features of pediatric orbital wall fracture.Methods: The MEDLINE literature database was searched for English language articles containing the following keywords: “pediatric orbital wall fracture,” “pediatric orbital blow-out fracture,” “pediatric orbital trapdoor fracture,” “orbital floor fractures in children,” “orbital blow-out fractures in children,” and “orbital trapdoor fractures in children.” The authors critically evaluated the unique aspects of orbital wall fractures in children with regard to epidemiology, clinical presentation, surgical management, and outcomes.Results: Orbital wall fractures in children are less common compared with in adults. The pattern of orbital fracture changes as children age because of the ongoing evolution in pediatric facial skeletal anatomy. Although the management of pediatric orbital fractures continues to progress, a thorough clinical assessment with computed tomography scan imaging remains essential. Urgent surgical intervention is indicated in cases of entrapment or severe hypoglobus. Entrapment with oculocardiac reflex is common in white-eyed blow-out or trapdoor fractures. Otherwise, pediatric fractures can be treated conservatively with surveillance. A variety of autogenous and allogenic materials may be used to repair the fractured orbit.Conclusion: Adult treatment algorithms are often not ideal for the management of orbital fractures in children in major part due to differences in the maturing status of the craniofacial structures. A multidisciplinary approach that utilizes imaging studies, an awareness of occult extraocular muscle entrapment, and an emphasis on the findings on physical examination should be employed to diagnose and treat pediatric orbital floor fractures. These injuries can be grouped into two categories based on the status of inferior extraocular muscles, as follows: (1) entrapped or “trapdoor” floor fractures and (2) nonentrapped orbital floor fractures. The former requires earlier intervention.