Pediatric orbital floor fracture - Direct extraocular muscle involvement

Objective: To study the clinical presentation, operative findings, and post operative results of a surgical series of isolated orbital floor fractures in children. Design: Noncomparative, retrospective, consecutive case series. Participants: Thirty-four patients (34 orbits) less than 18 years of age wi th isolated orbital floor fractures. Indications for surgery were severe li mitation of extraocular ductions, 22 of 34; enophthalmos, 8 of 34: or both, 4 of 34. Intervention: Surgical repair. Main Outcome Measures; Cause of fracture, symptoms, clinical signs, radiogr aphic data, operative findings, postoperative results, and complications. Results: Children older than 12 years of age were more likely to sustain an orbital floor fracture as a result of interpersonal violence than were chi ldren less than 12 years of age (P = 0.020), Sixty-two percent of patients (21 of 34) exhibited pain with eye movements and/or nausea and vomiting, Mo st had a trapdoor type fracture (21 of 34), The inferior rectus muscle was entrapped in the orbital floor fracture in 69% (18 of 26) of patients with a severe limitation of ocular ductions. Preoperative nausea and vomiting we re immediately relieved after surgery. The median time for improvement of p reoperative duction deficits and diplopia was 4 days for patients receiving surgery within 7 days and 10.5 days for those undergoing surgery after 14 days (P = 0.030). Resolution of duction deficits or diplopia was not depend ent on time of surgery if performed within 1 month of injury. Loss of visio n, worsening of motility, or implant complications did not occur. Conclusions: Pediatric patients with isolated orbital floor fractures who h ad pain, nausea, vomiting, and severe limitation of extraocular motility of ten have direct entrapment of the inferior rectus muscle into the fracture site. Surgical repair rapidly relieved preoperative pain, nausea, and vomit ing. For patients with severe limitation of ductions, early surgical repair within 7 days of injury resulted in more rapid improvement of ductions and diplopia than surgery performed later. Ophthalmology 2000;107:1875-1879 (C ) 2000 by the American Academy of Ophthalmology.