Epidemiology and Outcome of Orbital Floor Fractures in Children at the Research Institute of Ophthalmology
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- Category: Vol. 84, December 2016
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Epidemiology and Outcome of Orbital Floor Fractures in Children at the Research Institute of Ophthalmology, AYMAN F. ELSHIATY, HISHAM A. HASHEM, SAMEH H. ABDEL BAKY, HESHAM F. KAMEL and OMAR M. SOLYMAN
Abstract
Purpose: To study the epidemiology of orbital floor fracture in children and evaluate the safety and effectiveness of different alloplastic materials used for its repair at the Research Institute of Ophthalmology (RIO) from January 2012 to December 2015.
Methods: This study is a retrospective, interventional, case series of patients aged 16 years or less with orbital floor fracture who presented to the department of oculoplastics at RIO from January 2012 to December 2015. Patient records were reviewed to confirm a diagnosis of orbital floor fractures, the underlying etiology, classification, associated injuries, surgical technique used in the reconstructive surgery including the implant material, the outcome of surgical reconstruction and any postoperative complications.
Results: A total of 22 patients with confirmed diagnosis of orbital floor fracture were identified. Four patients did not require surgery. The age of patients at presentation ranged from 7 to 16 year with a mean of 11.4 years. Only three patients were females (13.6%) and the rest of patients were males (86.4%). Accidental normal daily activity related trauma was the most common underlying cause and was responsible of 9 cases (40.9%), followed by interpersonal violence (5 cases, 22.7%). Eighteen cases required surgical reconstruction. Porous polyethylene was used as orbital floor implant in ten cases and porous polyethylene with embedded titanium mesh was used in eight cases. Follow-up period ranged between 6 and 28 months with average of 14.5 months. Complete reso-lution of diplopia in primary position and down gaze was achieved in 14 (87.5%) out of 16 children that presented with diplopia preoperatively. No patient developed postoperative diplopia worse than preoperatively. Enophthalmos was cor-rected in 4 (80%) out of 5 cases and partially improved in one case. No major or sight threatening complications were reported in this series.
Conclusion: Orbital floor fractures are much more common in boys compared to girls. The peak age in our series was around eleven years and it was uncommon in children under the age of 7 years. When presenting with oculocardiac reflex, orbital floor fractures should be considered as an emergency and urgent surgical repair should be performed. Imaging techniques may fail to show entrapment of extraocular muscle. When the clinical picture is suggestive of entrapment, surgical exploration should not be delayed so as to confirm the diagnosis and to prevent muscle damage that may happen with late management.