The Differences of Blowout Fracture of the Inferior Orbital Wall Between Children and Adults

Kwon, Jae Hwan; Moon, Jung Hwan; Kwon, Min Sang; Cho, Joong Hwan

doi:10.1001/archotol.131.8.723

Cited by 93 publications

(69 citation statements)

References 6 publications

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“…Numerous studies have been performed on orbital fractures so far [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. However, much of the literature is either out of date or based on small groups of patients.…”

Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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Purpose: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist’s perspective. Methods: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. Results: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the ‘comminuted’ one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (≧2 mm) patient population was improved from 2.62 (±SD 0.9) to 1.73 (±SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. Conclusion: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

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Section: Introductionmentioning

confidence: 99%

An Analysis of 733 Surgically Treated Blowout Fractures

Jung

Shin

et al. 2009

Ophthalmologica

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“…13 The published prognostic factors associated with the persistence of long-term ophthalmological sequelae are primarily clinical and include the presence of severe preoperative diplopia and young age. [18][19][20] Radiologically, the main factor reported to be associated with persistent diplopia is contracture of the inferior rectus muscle. 11 The presence of such a lesion is mainly based on detecting muscle edema, which is evaluated by establishing a ratio relative to the contralateral muscle.…”

Section: Discussionmentioning

confidence: 99%

Can a Specific Computed Tomography-Based Assessment Predict the Ophthalmological Outcome in Pure Orbital Floor Blowout Fractures?

Bruneau

Haller

Courvoisier

et al. 2016

Journal of Craniofacial Surgery

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The aim of this study was to determine the predictive value of a specific computed tomography (CT)-based assessment for the final functional ophthalmological outcome in pure orbital floor blowout fractures. Data of 34 consecutive patients with pure blowout fractures who had undergone a period of at least 6 months of medical and ophthalmological follow-up were analyzed. The following 3 CT scan-based parameters were included: area ratio of the fractured orbital floor (RF), maximum height of periorbital tissue herniation (MH), and a 4-grade muscular subscore (MSS) describing the inferior rectus muscle displacement relative to the orbital floor level. The orthoptic complications (diplopia, enophthalmos, and ocular motility restriction) were evaluated by an experienced strabologist. The CT parameters' predictive value was analyzed using receiver operating characteristic curves and area under the curve (AUC), logistic regression, and Spearman correlation.The RF had a significant predictive value for enophthalmos appearance (AUC ¼ 0.75, P ¼ 0.02), and MH for diplopia (AUC ¼ 0.80, P ¼ 0.03). Among patients with complications, the relevance of MSS and MH as well as the severity of vertical deviation were also clinically strongly associated (rho ¼ À0.52 and À0.56).Our study revealed the significantly predictive value of RF for occurrence of enophthalmos and of MH for diplopia persistence. Although statistically unable to predict the occurrence of ocular motility restriction, MH and MSS were clinically strongly correlated with the severity of ocular deviation limitations.

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“…The elasticity enables young bone to return to its original position after displacement during a fracture. 21,22 Consequently orbital contents that may have been extruded during the force of trauma can be trapped in the fracture as the bone rebounds into place. The term "trapdoor" is used to describe this type of fracture.…”

Section: Discussionmentioning

confidence: 99%