Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center

Abstract

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures.ObjectiveOur study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures

Pediatric orbital fractures

“…Although pediatric facial trauma is overall rare, orbital fractures are common, ranging from 20 to 56% of facial fractures [1,2 ▪▪ ,3,4 ▪ ]. The incidence of fractures changes as children age due to the development of the sinuses.…”

“…The incidence of fractures changes as children age due to the development of the sinuses. Orbital roof fractures are most common in children under five; by the age of seven, floor fractures become most common [1,2 ▪▪ ]. Boys are more likely to sustain facial fractures [1,2 ▪▪ ].…”

“…Orbital roof fractures are most common in children under five; by the age of seven, floor fractures become most common [1,2 ▪▪ ]. Boys are more likely to sustain facial fractures [1,2 ▪▪ ]. Motor vehicle accidents (MVAs) are the most common mechanism of injury, followed by assault or sports-related injuries in older children and falls in younger children [1,2 ▪▪ ,3].…”

“…Boys are more likely to sustain facial fractures [1,2 ▪▪ ]. Motor vehicle accidents (MVAs) are the most common mechanism of injury, followed by assault or sports-related injuries in older children and falls in younger children [1,2 ▪▪ ,3]. Several studies have examined potential shifts in the incidence and the mechanism of injury in pediatric facial fractures during the COVID pandemic.…”

“…After initial trauma survey, noncontrast computed tomography (CT) scan with 1.5 mm cuts is the recommended imaging modality to assess craniofacial trauma [8]. A large retrospective study of 116 patients with orbital fractures by Halsey et al [2 ▪▪ ] found that 30% of patients presented with associated periorbital and/or globe injuries. Given this high incidence, it is recommended that all patients with orbital fractures undergo ophthalmologic evaluation [9 ▪ ].…”