Purchase this article with an account.
K. E. Galler, K. Parbhu, L. A. Mawn; Missed Radiologic Diagnosis of Soft Tissue Entrapment in Orbital Fractures in the Pediatric Population Compared to the Adult Population. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5488.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare the timing, radiologic, and clinical indication for surgical management of orbital floor fractures in the pediatric and adult populations.
The records of all pediatric and adult patients who underwent primary repair of an orbital floor fracture by a single surgeon on the oculoplastics service at Vanderbilt Eye Institute between December 1, 1998 and December 1, 2006 were reviewed. Variables assessed for each population included age, sex, mechanism of injury, time to surgical intervention, clinical indication for surgical intervention, official CT report, intraoperative findings, and associated injuries.
24 pediatric patients and 31 adult patients were identified. Of the 24 pediatric patients, 17 were male. The mean age at injury was 11.8 (range 2-17) years. Of the 31 adult patients, 20 were male. The mean age at injury was 35.5 (range 19-69). The mechanism of injury in pediatric floor fractures included: motor vehicle accident in 10, fall in 7, sports-related injury in 4, and assault in 3. The mechanism of injury in adult floor fractures included: motor vehicle accident in 13, sports-related injury in 6, assault in 6, fall in 5, and gunshot wound in 1.The mean time to surgical intervention differed between the pediatric (mean 7.38 days, range 0-39) and adult (mean 36.8 days, range 0-221) populations (p<0.01). The clinical indication for surgery in the pediatric group was entrapment in 21, enophthalmia in 2, and large fracture in 1. The clinical indication for surgery in the adult group was enophthalmia in 14, large floor fracture in 11, and entrapment in 6. Radiologic evidence of entrapment was reported in 9 pediatric cases whereas an intraoperative finding of entrapment was seen in 21 cases (p=0.0005, concordance rate of 50%). Radiologic evidence of entrapment was reported in 7 adult cases while an intraoperative finding of entrapment was seen in 8 cases (p=0.625, concordance rate of 87%).
In our series, pediatric orbital floor fractures were repaired on average 3 weeks earlier than the adult fractures. The most common clinical indication for surgery was entrapment in the pediatric group versus enophthalmia in the adult group. Notably, there was a statistically significant underestimation of entrapment reported on CT in the pediatric group when compared to the clinical indications and intraoperative findings, suggesting that clinical exam may be more sensitive at detecting entrapment than CT in the pediatric population. Interestingly, there is good concordance between radiologic, clinical and intraoperative findings in the adult population.
This PDF is available to Subscribers Only