Roof Fractures Research Articles

Surgical techniques in orbital roof fractures: early treatment and results

Repositioning of fractured fragments, stabilization with miniplates and reconstruction using autologous bone are commonly used techniques in the treatment of fractures of the orbital roof. Between 1988 and 1993, 101 patients were operated upon transcranially in the Department of Neurosurgery of the Landesnervenklinik Salzburg, for fractures of the orbital roof. The method, the timing and the results of treatments are presented. It can be demonstrated that even in severely injured patients the results were good in 79.2% (80 patients).

The role of CT and MRI in the investigation of orbital roof fractures

The role of CT and MRI in the investigation of orbital roof fractures

Role of CT and MR imaging in the assessment of orbital roof fractures: A presentation of three cases

Role of CT and MR imaging in the assessment of orbital roof fractures: A presentation of three cases

The management of orbital roof fractures

The nature and aetiology of orbital roof fractures is discussed and a strategy for their successful management outlined with reference to five clinical cases. Early recognition and treatment of these fractures reduces the high incidence of intra-cranial and ocular complications and the importance of a combined approach involving maxillofacial surgeons, neurosurgeons and ophthalmologists is emphasised. A coronal flap together with frontal craniotomy is recommended for surgical access to the orbital roof and overlying dura. When reconstruction is indicated, autogenous bone harvested from the inner table of the calvarium provides an ideal graft material.

Displaced Orbital Roof Fractures

Of 457 patients with facial fractures admitted by the plastic surgery service from 1986 to 1988 at Wayne State University, there were seven displaced orbital roof fractures in five patients. All presented with supraorbital rim fractures, inferior dystopia, limitation of supraduction, upper eyelid ptosis, and diplopia. Proptosis was present in four orbits in three patients. One of these patients had an orbital floor fracture. However, enophthalmos was present in three orbits in two patients with associated zygoma and floor fractures. Two patients had intracranial neurologic injuries, but no ocular injuries were seen. Patients underwent frontal craniotomy and removal of the supraorbital rim for exposure. The orbital roof was reconstructed with outer-table cranial bone grafts. Associated fractures were repaired. Mean follow-up was 21.4 months. In all patients, the inferior dystopia, proptosis or enophthalmos, limitation of supraduction, and diplopia were corrected. In one patient, residual mild eyelid ptosis was seen. No residual neurologic or ocular injury was seen.

Orbital Roof Fractures in the Pediatric Population

Twenty-three patients aged 3.3 +/- 1.6 years (mean +/- SD) presented between January of 1984 and September of 1987 with fronto-orbital trauma resulting in fractures of one (N = 20) or both (N = 3) orbital roofs. All patients had computed tomography (CT) with axial and coronal sections that revealed three fracture patterns of the orbital roof (nondisplaced, superiorly displaced, and inferiorly displaced fractures). Orbital dystopia was exhibited in 35 percent (N = 8) of the patients. Exophthalmos was noted in 61 percent (N = 14) of the patients. Only 30 percent of the patients (N = 7) sustained associated maxillofacial fractures. Eight percent of fractures exhibited orbital encephaloceles. All patients lacked frontal sinus pneumatization. The majority of children with orbital roof fractures do not exhibit concomitant facial fractures. CT utilizing both axial and coronal sections is valuable in defining the extent and pattern of the fracture as well as in identifying associated neurologic injuries. Large, displaced orbital roof fractures, which occurred in 3 of 13 patients with displaced fractures in our series, should undergo early reduction to avoid late development of encephalocele.

Orbital Roof Fractures in the Pediatric Population

Twenty-three patients aged 3.3 +/- 1.6 years (mean +/- SD) presented between January of 1984 and September of 1987 with fronto-orbital trauma resulting in fractures of one (N = 20) or both (N = 3) orbital roofs. All patients had computed tomography (CT) with axial and coronal sections that revealed three fracture patterns of the orbital roof (nondisplaced, superiorly displaced, and inferiorly displaced fractures). Orbital dystopia was exhibited in 35 percent (N = 8) of the patients. Exophthalmos was noted in 61 percent (N = 14) of the patients. Only 30 percent of the patients (N = 7) sustained associated maxillofacial fractures. Eight percent of fractures exhibited orbital encephaloceles. All patients lacked frontal sinus pneumatization. The majority of children with orbital roof fractures do not exhibit concomitant facial fractures. CT utilizing both axial and coronal sections is valuable in defining the extent and pattern of the fracture as well as in identifying associated neurologic injuries. Large, displaced orbital roof fractures, which occurred in 3 of 13 patients with displaced fractures in our series, should undergo early reduction to avoid late development of encephalocele.

Orbital Roof Fractures in the Pediatric Population

Orbital Roof Fractures in the Pediatric Population

Orbital Roof Fractures in Childhood

The authors documented 36 orbital roof fractures in 32 children over a 5-year period. With the aid of computed tomography (CT), 16 fractures were classified as isolated and 20 were found to be associated with more extensive damage to the skull. Isolated fractures typically occurred in younger children (mean age, 2.8 years) after relatively minor trauma, most often a fall from a height of less than 10 feet. Birth trauma was the cause in one case. Three fourths of the isolated fractures were linear; with extensive trauma, the orbital roof was usually comminuted. Upper eyelid hematoma characteristically developed hours after the traumatic event. There were no significant chronic disturbances of vision, motility, or lid function. Acute neurologic concerns were common, and two patients died, but full recovery was otherwise the rule. In two cases, late development of ocular pulsation led to CT demonstration of encephaloceles. Both of these children had comminuted roof fractures with displacement of bone fragments into the orbit. The authors conclude that fracture of the orbital roof is a common but frequently overlooked occurrence in childhood. Anatomic factors may account for differences in the effect of frontal impact at different ages.

Compressive Optic Neuropathy Following Use of Intracranial Oxidized Cellulose Hemostat

A 35-year-old white male sustained head injuries in a motor vehicle accident. He underwent neurosurgical repair of a frontotemporal skull fracture and lacerated left frontal lobe; regenerated oxidized cellulose (Surgicel) was placed into the anterior cranial fossa for hemostasis. Forty-eight hours after surgery he suffered rapid deterioration of vision to no light perception from optic nerve compression. Radiologic and echographic evaluation demonstrated a subperiosteal soft tissue density in the orbital apex consistent with hematoma. At surgery for optic canal decompression, the cellulose hemostat was found in the apex of the left orbit, having migrated through orbital roof fractures, and had apparently caused the compressive optic neuropathy. Decompression resulted in return of vision to the level of counting fingers.

Complications of Orbital Roof Fractures

A spectrum of complications of orbital roof fractures is discussed. The authors have had cooperation with the neurosurgical service in treating nine cases. Careful ocular and neurologic examination of the patient is emphasized in an attempt to avoid ocular complications, orbital deformities, ocular muscular imbalance, enophthalmos, blepharoptosis, and intracranial complications. With intracranial involvement, a combined neurosurgical and ophthalmologic approach is indicated. A superior orbitomy is indicated if there is a simple fracture of the orbital roof without involvement of the inner table of the skull.

Orbital Roof Fractures: Neurologic and Neurosurgical Considerations

A wide spectrum of orbital roof fractures is presented through four clinical cases. Neurologic examination is emphasized and reviewed in order to detect the orbital roof fractures that may involve intracranial damage. A combined neurosurgical and ophthalmologic approach is indicated in basilar skull fractures with involvement of the inner table. Without intracranial damage or evidence of a dural tear, a superior orbitotomy is indicated to reduce the fracture and release the incarcerated orbital contents to improve ocular motility.

Terrestrial analogs to lunar dimple (drainage) craters

In addition to modes of formation offered by previous investigators, terrestrial drainage craters formed over lava tubes in Oregon are presented as analogs to lunar drainage craters. Craters associated with lava tubes result from: (1) drainage of surface material through roof fractures; (2) plastic collapse of the partially cooled lava tube roof; and (3) drainage of surface material into roof collapses. The former two categories result in shallow, often elongate craters; the latter category forms classic ‘dimple’ shaped craters. Elongate dimple craters formed over volcanic fissures in southern Idaho are also discussed and presented in support of one mode of formation proposed by previous investigators for lunar drainage craters. Movement of surface material toward the orifice is initiated on Earth largely by wind and water; in lunar conditions, initial movement is attributed to micro- and macro-meteoritic bombardment, seismic disturbances generated by internal and external processes, and by thermal creep.