Endoscope-Assisted Repair of Pediatric Trapdoor Fractures of the Orbital Floor: Characterization and Management

Abstract

Background: The mechanism of injury, the clinical presentation, the natural history, and the indications for the treatment of orbital fractures in the pediatric population are less well described than they are in adults. The purpose of this study was to describe the specific characteristics and management of trapdoor fractures of the orbital floor in the pediatric population. Methods: We enrolled 18 pediatric patients younger than 13 years who underwent endoscopic reconstruction of trapdoor fractures of the orbital floor between March 2000 and October 2006 at the Gil Medical Center and the Ansan Hospital, Korea University. Causes, locations, and clinical characteristics such as restriction of extra-ocular muscle movement were reviewed retrospectively. Results: Ten of 18 patients (55.6%) exhibited nausea and vomiting, which rapidly resolved after surgery. Surgery was undertaken within 2 weeks after injury (82.3%), and most of the extraocular muscle movement restrictions improved within 2 months postoperatively. Temporary postoperative hypertropia occurred in 5 floor fractures (5/16, 31.2%). Conclusions: Trapdoor fractures of the orbital floor revealed a high incidence of persistent diplopia associated with extraocular muscle and soft tissue entrapment in the pediatric population, but actual entrapment of the muscle belly was confirmed in only 27.8% of patients endoscopically. Temporary hypertropia (31.2%) occurred in trapdoor fractures of the orbital floor but improved after 2 months of follow-up in every patient. Marked motility restriction and nausea/vomiting are predictive of trapdoor fractures. Prompt surgical intervention is needed in patients with such symptoms.