Reconstruction of an Orbital Floor Fracture in a 4-Year-Old Child

Abstract

The most frequent orbital wall fractures involve the orbital floor. Such fractures can be divided into transmarginal and retromarginal (blowout) fractures. Two theories of retromarginal fracture aetiology have been described: the hydraulic theory and the bone conduction mechanism.The former refers to a direct force to the globe and its compression (blowout), which increases intraorbital pressure and leads to a fracture of the weakest point of the orbital bone (the orbital floor or the medial orbital wall). The latter suggests a force to the lower orbital rim, which transfers pressure to the orbital floor and results in its fracture (9).A conservative or a surgical therapeutic approach should be selected according to the extent and localization of the injury and according to the difficulties exhibited by the patients. In addition, retromarginal fractures of the orbital floor in children are unique due to the pathology involved in the orbital bone injury and due to a distinctive surgical approach.The report presents a fracture of the orbital floor in a child. Furthermore, therapeutical options in retromarginal fractures of the orbital floor are discussed. Case ReportA 4-year-old girl was running in a garden and hit her face against an agricultural machine. Subsequently, she started to bleed from her nose, and a haematoma of her left lower eyelid and her left cheek developed. She did not have any period of unconsciousness. A CT examination of the orbits and the paranasal sinuses in the coronal plane revealed a retromarginal fracture of the orbital floor with large soft tissue herniation into the maxillary antrum ( Fig. 1) with no ocular muscle restriction. A consulting ophthalmologist did not find any visual acuity impairment. Furthermore, movements of the eyeballs were not restricted, and the child did not report diplopia. Oedema subsided on the 6th day after the injury, and surgery was performed. The indication for surgery was a large soft tissue herniation in the maxillary sinus. Bone fragments of the orbital floor and a tear of the perforated orbital periosteum were found after performing a transconjuctival incision combined with a lateral canthotomy. After lifting the soft orbital tissues and the orbital periosteum from the maxillary antrum, a partly absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum to provide support. A forced duction test prior to and after the reduction proved an absence of extraocular muscle restriction. Next, the incision was sutured. After the surgery the child made an uneventful recovery, her visual acuity was not impaired, her eyeball movements were not restricted, and diplopia was not present. A follow-up MRI examination of the orbits and the paranasal sinuses one month after the surgery demonstrated the collagenous mesh and the orbital soft tissues in a good position without any signs of dislocation into the maxillary antrum (Fig. 2). DiscussionThe region medial to the infraorbital neurovascular bundle, approximately 10 mm posterior to...

Biomaterials and implants for orbital floor repair

“…In the field of orbital floor repair, gelatin has been associated to relatively rare clinical complications [83]. Collagenous mesh was also successfully used to repair orbital floor fracture in children without postoperative complications [85].…”

The Importance of Historical Medical Records Review in the Interpretation of Dry Bone Lesions on Identified Skeletal Remains

“…At present, the mastoid process has been completely removed up to the internal table of the skull, and the skin is closed under the antibiotic barrier, creating a visible depression behind the ear. 22 The state of the partially healed fracture of the left crus and toe amputation from 1939, that is, 1.5 years before death, fully correspond to the known circumstances of the event and their consequences, as well as to the information in the autopsy protocol. The spikes around the fracture of thr fibula indicate significant contusion and bleeding in the soft tissues with subsequent ossification.…”

“…This case, however, is not one of these, either socioeconomically or in terms of physical condition, despite all the recorded diseases. At present, the mastoid process has been completely removed up to the internal table of the skull, and the skin is closed under the antibiotic barrier, creating a visible depression behind the ear 22 …”