Management of pediatric orbital wall fractures

Backgraound: The purpose of this study was to review the clinical features of pediatric orbital wall fracture. Methods: The MEDLINE literature database was searched for English language articles containing the following keywords: “pediatric orbital wall fracture,” “pediatric orbital blow-out fracture,” “pediatric orbital trapdoor fracture,” “orbital floor fractures in children,” “orbital blow-out fractures in children,” and “orbital trapdoor fractures in children.” The authors critically evaluated the unique aspects of orbital wall fractures in children with regard to epidemiology, clinical presentation, surgical management, and outcomes. Results: Orbital wall fractures in children are less common compared with in adults. The pattern of orbital fracture changes as children age because of the ongoing evolution in pediatric facial skeletal anatomy. Although the management of pediatric orbital fractures continues to progress, a thorough clinical assessment with computed tomography scan imaging remains essential. Urgent surgical intervention is indicated in cases of entrapment or severe hypoglobus. Entrapment with oculocardiac reflex is common in white-eyed blow-out or trapdoor fractures. Otherwise, pediatric fractures can be treated conservatively with surveillance. A variety of autogenous and allogenic materials may be used to repair the fractured orbit. Conclusion: Adult treatment algorithms are often not ideal for the management of orbital fractures in children in major part due to differences in the maturing status of the craniofacial structures. A multidisciplinary approach that utilizes imaging studies, an awareness of occult extraocular muscle entrapment, and an emphasis on the findings on physical examination should be employed to diagnose and treat pediatric orbital floor fractures. These injuries can be grouped into two categories based on the status of inferior extraocular muscles, as follows: (1) entrapped or “trapdoor” floor fractures and (2) nonentrapped orbital floor fractures. The former requires earlier intervention.