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Y. J. Park, A. Abazari, S. A. Newman; Growing Fractures of the Orbital Roof: An Unusual Complication. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3526.
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Fractures of the orbital roof are an uncommon but not rare complication of orbital trauma. Essentially all cases are associated with tear in the dura. Most will close spontaneously but some have persistent egress of CSF into the subperiosteal orbital content.
A case series of 2 patients seen at the University of Virginia with growing fractures of the orbital roof are presented to characterize the findings in these patients and emphasize the importance of recognizing the dural tear and its consequence to the orbital roof and the importance of closing the dura.
Two children ages 10 and 2 were followed at the University of Virginia. Both presented with evidence of increasing dystopia with one eye depressed inferiorly. Imaging in both cases demonstrated thickening of the orbital roof and evidence of a previous fracture. Surgical approach to both patients revealed evidence of a dural tear with continued CSF egress into the orbit resulting in bony overgrowth of the orbital roof and thickening. Removal of the thickened orbital roof and closure of the dura improved globe position in both cases.
Fractures of the orbital roof are essentially always associated with dural tear. While most of these will close spontaneously, failure to do so can result in continued bony overgrowth possibly due to stimulation of osteoblasts by CSF. Follow up imaging of patients with orbital roof fractures may be indicated to earlier identify those with progressive thickening of the orbital roof before globe displacement occurs.
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