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Oral and Maxillofacial Surgery Clinics... Nov 2023The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment... (Review)
Review
The unique anatomy and physiology of the growing craniofacial skeleton predispose children to different fracture patterns as compared to adults. Diagnosis and treatment of pediatric orbital fractures can be challenging. A thorough history and physical examination are essential for the diagnosis of pediatric orbital fractures. Physicians should be aware of symptoms and signs suggestive of trapdoor fractures with soft tissue entrapment including symptomatic diplopia with positive forced ductions, restricted ocular motility (regardless of conjunctival abnormalities), nausea/vomiting, bradycardia, vertical orbital dystopia, enophthalmos, and hypoglobus. Equivocal radiologic evidence of soft tissue entrapment should not withhold surgery. A multidisciplinary approach is recommended for the accurate diagnosis and proper management of pediatric orbital fractures.
Topics: Adult; Child; Humans; Orbital Fractures; Tomography, X-Ray Computed; Nausea; Vomiting; Physical Examination; Enophthalmos
PubMed: 37302946
DOI: 10.1016/j.coms.2023.05.002 -
Current Opinion in Otolaryngology &... Aug 2023The aim of this study was to summarize current evidence on the clinical presentation, evaluation, and management of pediatric orbital fractures. Recent trends in... (Review)
Review
PURPOSE OF REVIEW
The aim of this study was to summarize current evidence on the clinical presentation, evaluation, and management of pediatric orbital fractures. Recent trends in management strategies as well as emerging surgical techniques for pediatric orbital fracture repair are presented.
RECENT FINDINGS
Although somewhat limited, growing bodies of evidence support a conservative approach with close follow up in pediatric orbital fractures. For those patients necessitating surgical repair, resorbable implants are increasingly preferred given their lack of donor site morbidity and a minimal impact on the developing craniofacial skeleton. There are emerging data reporting the use of three-dimensional (3D) printing-assisted approaches and intraoperative navigation; however, more research is needed to assess their applicability in the pediatric population.
SUMMARY
There are few studies with large patient cohorts and long-term follow up given the rare incidence of pediatric orbital fractures, which restricts the generalizability of research on the topic. The studies available increasingly suggest that fractures without clinical evidence of entrapment can be managed conservatively with close follow up. A variety of reconstructive implants are available for those fractures necessitating repair. Donor site morbidity, availability, and need for additional procedures should all be factored into the reconstructive decision-making process.
Topics: Child; Humans; Orbital Fractures; Plastic Surgery Procedures; Incidence; Printing, Three-Dimensional
PubMed: 36976962
DOI: 10.1097/MOO.0000000000000887 -
Tidsskrift For Den Norske Laegeforening... Apr 2022
Topics: Humans; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 35383443
DOI: 10.4045/tidsskr.21.0586 -
Facial Plastic Surgery Clinics of North... Feb 2022The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the... (Review)
Review
The bony orbit is commonly involved in athletic injuries. Evaluation should include a comprehensive history and ocular examination. Computed tomography imaging is the gold standard for diagnostic testing. Urgent surgical intervention for orbital floor fractures should occur after "white eye" trapdoor fractures or if oculocardiac response occurs. Most orbital fractures do not require urgent intervention and repair can be completed within 2 weeks of injury. There are many approaches to repair orbital fractures, and consideration of techniques depends on the unique fracture pattern. Intraoperative computed tomography has become frequently used and can lead to increased identification of plate malpositioning intraoperatively.
Topics: Athletic Injuries; Facial Bones; Humans; Orbit; Orbital Fractures; Tomography, X-Ray Computed
PubMed: 34809885
DOI: 10.1016/j.fsc.2021.08.003 -
Advanced Emergency Nursing Journal 2017The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The floor of the orbit is the weakest portion of this 4-sided pyramid... (Review)
Review
The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The floor of the orbit is the weakest portion of this 4-sided pyramid structure. Blunt force trauma is the primary mechanism of injury in young men between the ages of 18 and 30 years. Computerized tomography is the primary imaging technique to diagnose orbital fractures. Conservative versus surgical management is determined by maxillofacial and ophthalmology specialists.
Topics: Conservative Treatment; Diagnosis, Differential; Fracture Fixation; Humans; Orbital Fractures; Risk Factors; Tomography, X-Ray Computed
PubMed: 29095175
DOI: 10.1097/TME.0000000000000163 -
The Journal of Craniofacial Surgery Jul 2011The clinical presentation and management of pediatric orbital fractures have many unique features that differentiate them from orbital injuries encountered in the adult... (Review)
Review
The clinical presentation and management of pediatric orbital fractures have many unique features that differentiate them from orbital injuries encountered in the adult population. An understanding of the particular anatomic and mechanical properties of pediatric orbital bone and soft tissue helps to explain most of these differences. This article reviews the epidemiology, anatomy, growth implications, pathomechanics, particular clinical features, assessment, and surgical management of pediatric orbital fractures.
Topics: Biomechanical Phenomena; Calcification, Physiologic; Child; Humans; Maxillofacial Development; Orbit; Orbital Fractures; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 21772209
DOI: 10.1097/SCS.0b013e31821c0f52 -
Current Opinion in Ophthalmology Sep 2017The current study reviews the recent literature on pediatric orbital blowout fractures and provides guidelines on their management. (Review)
Review
PURPOSE OF REVIEW
The current study reviews the recent literature on pediatric orbital blowout fractures and provides guidelines on their management.
RECENT FINDINGS
The most common problem among patients requiring surgical revision of a previously repaired orbital floor fracture is an improperly placed orbital floor implant, usually erroneously placed under the posterior bony ledge. Although the transconjunctival incision can be combined with a lateral canthotomy and cantholysis, excellent surgical exposure can be obtained without the need for these latter relaxing maneuvers. In surgically repaired pediatric orbital blowout fractures with preoperative diplopia (both trapdoor and nontrapdoor), approximately 85% of patients recover completely over time. Delayed orbital tissue atrophy may play a role in the development of late enophthalmos.
SUMMARY
Most cases of pediatric orbital fracture can initially be followed conservatively to determine if disabling diplopia, when present, resolves without surgery. A notable exception is the trapdoor fracture, in which herniated tissue becomes entrapped by a recoiled bone fragment, causing marked or complete reduction in motility and/or an oculocardiac reflex; we recommend that these fractures be repaired within 24 h from the time of diagnosis. Enophthalmos resulting from an orbital floor fracture does not need to be prevented with early surgery. Enophthalmos can be allowed to develop over time to determine if it is noticeable, and then repair undertaken, if necessary, at that time. When surgery is indicated, a simple transconjunctival incision is preferred over a cutaneous incision, and care should be taken to insure that the implant is placed on the bony ledge at the posterior edge of the defect. Many children with blowout fractures will not require surgery, and those that do usually have excellent outcomes provided the recommendations are closely followed.
Topics: Child; Fracture Fixation; Global Health; Humans; Incidence; Orbital Fractures; Orbital Implants; Tomography, X-Ray Computed; Trauma Severity Indices
PubMed: 28797015
DOI: 10.1097/ICU.0000000000000407 -
Orbit (Amsterdam, Netherlands) Apr 2021: To summarize the radiological findings in patients with orbital blowout fractures. : We reviewed the published literature on radiological findings of orbital blowout... (Review)
Review
: To summarize the radiological findings in patients with orbital blowout fractures. : We reviewed the published literature on radiological findings of orbital blowout fractures that were searched on PubMed and included our own radiologic findings on patients with orbital blowout fractures that were seen at our hospital. : Radiologic examination reveals a variety of findings in each case. However, common radiological findings of orbital blowout fractures include comminuted/unhinged, hinged, and linear fractures. These fractures are usually located in the orbital floor medial to the infraorbital nerve and in the medial orbital wall. Orbital fat is frequently herniated in the paranasal sinus or incarcerated at the fracture site. Orbital emphysema and haematoma sometimes occur as complications. : This review will provide surgeons with a better understanding of various radiological findings, which could be helpful in the management of patients with orbital blowout fracture.
Topics: Humans; Orbit; Orbital Diseases; Orbital Fractures; Paranasal Sinuses; Tomography, X-Ray Computed
PubMed: 32212885
DOI: 10.1080/01676830.2020.1744670 -
Ophthalmic Plastic and Reconstructive...To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and... (Review)
Review
PURPOSE
To explore the anatomy, etiopathogenesis, diagnosis and classification, current evidence on intervention and the surgical management of orbital roof fractures and defects (ORFD) for oculoplastic surgeons presented with such cases.
METHODS
A review of the current literature through the MEDLINE database using the following search terms: "orbital roof fracture (+treatment/management)," "orbital roof defect (+treatment/management)," "orbital roof erosion (+treatment/management)," "orbital roof repair," "orbital roof," "orbital fracture," "pediatric orbital roof (defect/fracture/erosion)," "orbital anatomy," and "orbital roof anatomy" was conducted. As relatively little has been published on this topic, inclusion criteria were broad and peer-reviewed articles judged to be of clinical importance, relevant to the aims of this review, were included. Non-English abstracts were also included if relevant. Year of publication was not a strict exclusion criterion, and older articles were judged for their suitability based on clinical importance and relevance to current practice. Additional references were obtained from citations in key articles and recommendations from the coauthors based on their areas of expertise.
RESULTS
The etiopathogenesis of ORFD varies. Classification systems have been formulated to guide management decisions and can range from conservative management to complex neurosurgery. Eyelid approaches have also been described. This review provides a summary of the evidence for each and a management framework oculoplastic surgeons can use when presented with ORFD.
CONCLUSION
Oculoplastic surgeons can be involved, either alone or as part of a multidisciplinary team, in the management of ORFD, and for some, conduct orbital approach reconstructive surgery.
Topics: Child; Humans; Orbit; Orbital Fractures; Plastic Surgery Procedures
PubMed: 34293784
DOI: 10.1097/IOP.0000000000002025 -
Ophthalmic Plastic and Reconstructive...The purpose of this study is to review the mechanisms in the development of orbital fractures. (Review)
Review
PURPOSE
The purpose of this study is to review the mechanisms in the development of orbital fractures.
METHODS
This is a comprehensive literature review that summarizes the mechanisms of developing orbital fractures.
RESULTS
There are 3 proposed mechanisms in the development of orbital fractures, which include the buckling, hydraulic, and globe-to-wall contact mechanisms. These mechanisms, as well as patient age, causes of injuries, and periorbital anatomy, influence the extent, sites, and patterns of orbital fractures.
CONCLUSION
A deeper understanding of these mechanisms helps us to detect and properly manage orbital fractures in the clinical setting.
Topics: Humans; Orbital Fractures; Eye Injuries; Eye; Face
PubMed: 37450646
DOI: 10.1097/IOP.0000000000002426