Growing skull fractures of the orbital roof: a multicentric experience with 28 patients

Zeitoun, Ibrahim M.; Ebeid, Kamal; Soliman, A. Y.

doi:10.1007/s00381-020-04918-7

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…Gerbino et al 5 commented on four thin-layer heterologous bone graft repairs in their retrospective review of 24 patients who underwent surgery for trap door repairs. Interestingly, Zeitoun et al 16 recently reported a multicentric case study of 28 patients with growing skull fractures of the orbital roof. Split rib grafting was performed for three pediatric patients within their cohort for orbital roof fracture reconstruction in conjunction with duraplasty.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Niklinska

Pontell

Jaeger

et al. 2021

FACE

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Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.

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Section: Discussionmentioning

confidence: 99%

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Niklinska

Pontell

Jaeger

et al. 2021

FACE

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“…This develops weeks to months following the initial traumatic event [30]. A retrospective study by Zeitoun et al [31 ▪▪ ] reported presenting symptoms as eyelid swelling, pulsatile proptosis, headaches, and seizures. Left unrecognized, symptoms can progress to diplopia, amblyopia, and orbital compartment syndrome due to compression of the optic nerve.…”

Section: Orbital Roofmentioning

confidence: 99%

“…Left unrecognized, symptoms can progress to diplopia, amblyopia, and orbital compartment syndrome due to compression of the optic nerve. All growing skull fractures require operative intervention and are typically managed via a transcranial approach with resection of the cyst and reconstruction of both dural and osseous defects [27,31 ▪▪ ]. Given this risk, it is imperative that management of these fractures is a multidisciplinary approach including neurosurgical evaluation with close follow-up [32].…”

Section: Orbital Roofmentioning

confidence: 99%

Pediatric orbital fractures

Coviello

Williams

Sivam

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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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.

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