![Show Menu](styles/mobile-menu.png)
![Page Background](./../common/page-substrates/page0046.jpg)
I
solated pediatric orbital fractures in the absence
of other injuries warranting surgery represent a
challenging and controversial area of manage-
ment.
1–3
Some patients present with clear and abso-
lute indications for reduction and internal fixation
(e.g., restrictive strabismus with obvious muscle
entrapment on imaging).
4
However, the majority of
children will have a less clear clinical picture, with
the risks of surgery balanced against the possibility
of a secondary deformity that can be highly chal-
lenging to correct (i.e., globe malposition).
5,6
Plastic
surgeons may understandably have a higher thresh-
old for recommending surgery to prevent potential
enophthalmos in the context of surgical disruption
of an orbit with residual growth potential of not
only bone but also soft tissue and extraocular mus-
cle function.
7
We aimed to quantitatively assess our
experience with isolated pediatric orbital fractures
Disclosure:
The authors have no financial interest
to declare in relation to the content of this article.
Copyright © 2016 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000002006
Devin Coon, M.D., M.S.E.
Martin Kosztowski, M.D.
Nicholas R. Mahoney, M.D.
Gerhard S. Mundinger,
M.D.
Michael P. Grant, M.D.,
Ph.D.
Richard J. Redett, M.D.
Baltimore, Md.
Background:
Pediatric orbital fractures represent a challenging and sometimes
controversial clinical problem. Patients may present with clear indications for
surgery, but most require balancing benefits against intraoperative and late
complications. The authors assessed these fractures at a state-designated oph-
thalmology referral center to develop criteria for surgery.
Methods:
Institutional review board approval was obtained to retrospectively
analyze pediatric trauma registry patients with orbital fracture diagnoses at the
Wilmer Eye Institute over 10 years. Patients were excluded if they did not un-
dergo a full ophthalmologic examination, never followed up after their injury,
or had significant facial fractures outside of the orbit.
Results:
One hundred fifty patients met selection criteria; 116 patients
(77 percent) completed all follow-up (average, 309 days). Two patients had
20/40 vision or worse at the end of follow-up. One hundred ten patients (71
percent) underwent surgery; 96 underwent acute repair (<3 weeks) and 11
underwent delayed repair (median, 49 days). Three patients required reopera-
tion, two for plate infection and one for hyperglobus, with an overall complica-
tion rate of 4.7 percent.
Conclusions:
The authors analyzed the largest series of operative pediatric
orbital fractures to propose criteria for surgical intervention. There are four
potential indications: (1) rectus muscle entrapment; (2) early enophthalmos;
(3) central-gaze diplopia or extraocular movement restriction after the resolu-
tion of swelling; and (4) loss of orbital support likely to produce secondary
changes in globe position and/or binocular stereo vision. In our series, appli-
cation of these principles offered excellent long-term aesthetic and ophthal-
mic outcomes with an acceptably low complication profile. (
Plast. Reconstr.
Surg.
137: 1234, 2016.)
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
From the Department of Plastic Surgery and the Division of
Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins
Medical Institutions.
Received for publication July 10, 2015; accepted November
18, 2015.
Presented at the 94th Annual Meeting of the American As-
sociation of Plastic Surgeons, in Phoenix, Arizona, April
11 through 14, 2015, and recipient of the 2015 Johns Hop-
kins/University of Maryland Plastic Surgery Dr. Chi-Tsung
Su Award for Best Research.
Principles for Management of Orbital Fractures
in the Pediatric Population: A Cohort Study of
150 Patients
PEDIATRIC/CRANIOFACIAL
Reprinted by permission of Plast Reconstr Surg. 2016; 137(4):1234-1240.
24