Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical indication analysis according to bony defect size in pediatric orbital wall fractures

  • Kim, Seung Hyun (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Choi, Jun Ho (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Hwang, Jae Ha (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Kim, Kwang Seog (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Lee, Sam Yong (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School)
  • Received : 2020.08.06
  • Accepted : 2020.10.12
  • Published : 2020.10.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods: We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results: A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01±2.99 years. The defect size (p=0.002) and fracture type (p=0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p<0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p=0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 ㎠ was obtained (sensitivity, 0.543; specificity, 0.724; p=0.002). Conclusion: The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 ㎠ may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.

Keywords

References

  1. Davidson EH, Losee JE. Pediatric facial fractures. In: Neligan PC, Rodriguez ED, Losee JE, editors. Plastic surgery: craniofacial, head and neck surgery and pediatric plastic surgery. Vol 3. 4th ed. London: Saunders Elsevier; 2018. p. 678-95.
  2. Hink EM, Durairaj VD. Evaluation and treatment of pediatric orbital fractures. Int Ophthalmol Clin 2013;53:103-15. https://doi.org/10.1097/IIO.0b013e31828b7913
  3. Oppenheimer AJ, Monson LA, Buchman SR. Pediatric orbital fractures. Craniomaxillofac Trauma Reconstr 2013;6:9-20. https://doi.org/10.1055/s-0032-1332213
  4. Lee HR, Jung GY, Lee DL, Shin HK. Pediatric orbital medial wall trapdoor fracture with normal computed tomography findings. Arch Craniofac Surg 2017;18:128-31. https://doi.org/10.7181/acfs.2017.18.2.128
  5. Rodriguez ED, Dorafshar AH, Manson PN. Facial injuries. In: Neligan PC, Rodriguez ED, Losee JE, editors. Plastic surgery: craniofacial, head and neck surgery and pediatric plastic surgery. Vol 3. 4th ed. London: Saunders Elsevier; 2018. p. 47-81.
  6. Kang DH. Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture. Arch Craniofac Surg 2019;20:347-53. https://doi.org/10.7181/acfs.2019.00724
  7. Choi SH, Kang DH, Gu JH. The correlation between the orbital volume ratio and enophthalmos in unoperated blowout fractures. Arch Plast Surg 2016;43:518-22. https://doi.org/10.5999/aps.2016.43.6.518
  8. Senese O, Boutremans E, Gossiaux C, Loeb I, Dequanter D. Retrospective analysis of 79 patients with orbital floor fracture: outcomes and patient-reported satisfaction. Arch Craniofac Surg 2018;19:108-13. https://doi.org/10.7181/acfs.2018.01837
  9. Kim HS, Jeong EC. Orbital floor fracture. Arch Craniofac Surg 2016;17:111-8. https://doi.org/10.7181/acfs.2016.17.3.111
  10. Lee HB, Lee SH. New anthropometric data for preoperative planning in orbital wall fracture treatment: the use of eyelid drooping. Arch Craniofac Surg 2018;19:248-53. https://doi.org/10.7181/acfs.2018.02096
  11. Losee JE, Afifi A, Jiang S, Smith D, Chao MT, Vecchione L, et al. Pediatric orbital fractures: classification, management, and early follow-up. Plast Reconstr Surg 2008;122:886-97. https://doi.org/10.1097/PRS.0b013e3181811e48
  12. Takahashi Y, Nakakura S, Sabundayo MS, Kitaguchi Y, Miyazaki H, Mito H, et al. Differences in common orbital blowout fracture sites by age. Plast Reconstr Surg 2018;141:893e-901e. https://doi.org/10.1097/PRS.0000000000004397
  13. Kim YJ, Kim JR, Yang JW. Functional outcomes compared between conservative treatment and surgical treatment of orbital wall fractures: a retrospective study. Ann Optom Contact Lens 2015;14:7-16.
  14. Hink EM, Wei LA, Durairaj VD. Clinical features and treatment of pediatric orbit fractures. Ophthalmic Plast Reconstr Surg 2014;30:124-31. https://doi.org/10.1097/IOP.0000000000000026
  15. Yoo YJ, Yang HK, Kim N, Hwang JM. Pediatric orbital wall fractures: prognostic factors of diplopia and ocular motility limitation. PLoS One 2017;12:e0184945. https://doi.org/10.1371/journal.pone.0184945

Cited by

  1. Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft vol.2, pp.2, 2020, https://doi.org/10.1177/27325016211001939