Internal orbital fractures in the pediatric age group - Characterization and management

Objectives To evaluate the specific characteristics and management of inter nal orbital fractures in the pediatric population. Designs Retrospective observational case series. Participants: Thirty-four pediatric patients between the ages of 1 and 18 y ears with internal orbital ("blowout") fractures. Methods: Records of pediatric patients presenting with internal orbital fra ctures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. Main Outcome Measures: Ocular motility restriction, enophthalmos, nausea an d vomiting, and postoperative complications. Results: floor fractures were by far the most common fracture type (71%). E leven of 34 patients required surgical intervention for ocular motility res triction. Eight were trapdoor-type fractures with soft-tissue incarceration ; five had nausea and vomiting. Early surgical intervention (<2 weeks) resu lted in a more complete return of ocular motility compared with the late in tervention group, Conclusions: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with mi nimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiti ng should alert the physician to the possibility of a trapdoor-type fractur e and the need for prompt surgical intervention. (C) 2000 by the American A cademy of Ophthalmology.