Complex Ocular Motor Disorders in Children

Brodsky, Michael C.; Baker, Robert S.; Hamed, Latif M.

doi:10.1007/978-1-4613-8457-1_7

Cited by 4 publications

(2 citation statements)

References 209 publications

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“…Of note, a positive forced traction test during the acute phase of injury may be derived from hemorrhage and/or edema within and around the fibrous septae which attach both the inferior rectus and inferior oblique muscles to the periorbita. 46 Although a forced duction test is performed, the acute phase of trauma (edema, hemorrhage) may also prevent the reliable differentiation of eye mechanical restriction from oculomotor nerve palsy (inferior division to the inferior oblique muscle). 46 Consequently, notwithstanding the forced duction test, orbital pain during various ductions, and CT scan may all contribute to accurate diagnosis, none of them achieves 100% sensitivity or specificity.…”

Section: Discussionmentioning

confidence: 99%

“…46 Although a forced duction test is performed, the acute phase of trauma (edema, hemorrhage) may also prevent the reliable differentiation of eye mechanical restriction from oculomotor nerve palsy (inferior division to the inferior oblique muscle). 46 Consequently, notwithstanding the forced duction test, orbital pain during various ductions, and CT scan may all contribute to accurate diagnosis, none of them achieves 100% sensitivity or specificity. 47 On surgical exploration of the orbital floor, it is crucial for surgeons to ascertain the more posterior border of the fracture line.…”

Section: Discussionmentioning

confidence: 99%

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Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Papadiochos

Petsinis

Tasoulas³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.

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Section: Discussionmentioning

confidence: 99%