Clinical features and management of posttraumatic subperiosteal hematoma of the orbit

Abstract

Traumatic subperiosteal hematoma (SpH) usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

Imaging Diagnosis ‐ Spontaneous Subperiosteal Vertebral Hemorrhage in a Greyhound

“…As in our patient, a cause of the hemorrhage was not identified in any of the previously reported canine cases. In some human cases of posttraumatic subperiosteal hematoma, the development of clinical signs has been reported to be delayed, with one patient remaining symptom free until 6 days following head trauma . The possibility of an earlier trauma in our patient was considered unlikely as the only trauma witnessed by the owners had occurred more than one year previously and the MRI characteristics of the hemorrhage were consistent with a hyperacute (hours old) timeframe .…”

“…Subperiosteal hematoma is an infrequent condition, most commonly reported in the human medical literature in relation to the orbit. Development of hemorrhage in this region has been reported to result from trauma, infection/inflammation, or an underlying coagulopathy . The condition is considered to be spontaneous when there is no evidence of an underlying pathogenic mechanism .…”

Traumatic Orbital Subperiosteal Hematoma With Acute Visual Compromise: Role of the Head and Neck Surgeon

“…Rapid evacuation either via fine-needle aspiration or orbital exploration with drainage has been well-documented. [5][6][7] Risks certainly exist with fine-needle aspiration including hematoma reaccumulation as well as insufficient drainage. Open approaches allow for complete clot evacuation with the added ability to address sites of active bleeding with pinpoint electrocautery and minimize recurrence with drain placement to provide passive egress.…”

“…Several case reports have described the rare entity of traumatic OSPH. [5][6][7] Despite these findings, there remains a paucity of primary literature addressing the appropriate management of this complex disorder. Currently described treatment options for traumatic OSPH include conservative management, needle aspiration, or surgical intervention.…”

Pediatric posttraumatic orbital subperiosteal hematoma

“…It is a rare condition which occurs following severe damage to subperiosteal blood vessels, mainly subsequent to facial traumas and most commonly in male children. 1,2 Less frequently, it appears secondary to extension of subgaleal hematomas, after surgeries, 3 or with involvement of periorbital sinuses. 4 In children, periosteum is not tightly affixed to the underlying bone, and rapid expansion of hematoma may occur.…”