Trapdoor Orbital Fracture in a Pediatric Patient. Case Report and 57-years of Literature Review
PDF

Keywords

Orbital Fractures
Maxillofacial Trauma
Orbital Trauma

How to Cite

1.
Costa SM, Ribeiro BC, Nunes DB, Greco BB. Trapdoor Orbital Fracture in a Pediatric Patient. Case Report and 57-years of Literature Review. Surg Insights [Internet]. 2022 Feb. 21 [cited 2024 Oct. 15];. Available from: https://mediterraneanjournals.com/index.php/si/article/view/626

Abstract

The blowout trapdoor fracture is a rare condition with more prevalence in pediatric patients. Surgeons and clinicians should be aware of this condition due to its severity, which can cause ophthalmoplegia, blindness, and even death. The present study reports a unique case of the surgical correction of trapdoor fracture with the incarceration of the inferior rectus muscle in the maxillary sinus associated with a severe oculocardiac reflex, unimproved nausea, and ophthalmoplegia. Together with that, a 57-years literature review is provided. The TF is linked with assaults and playing activities, in a 12,73 years-old mean age. The oculocardiac reflex is not a common association, 29,2%, being one of the most alarming symptoms. It is fundamental to the correct and early diagnosis, together with the forehand surgery, related to success in the first 72 hours.

https://doi.org/10.55085/si.2022.626
PDF

References

Broyles JM, Jones D, Bellamy J, Elgendy T, Sebai M, Susarla SM, et al. Pediatric Orbital Floor Fractures: Outcome Analysis of 72 Children with Orbital Floor Fractures. Plast Reconstr Surg. 2015 Oct; 136(4): 822-828. https://doi.org/10.1097/prs.0000000000001613

Coon D, Kosztowski M, Mahoney NR, Mundinger GS, Grant MP, Redett RJ. Principles for Management of Orbital Fractures in the Pediatric Population: A cohort Study of 150 Patients. Plast Reconstr Surg. 2016 Apr; 137(4): 1234- 1240. https://doi.org/10.1097/prs.0000000000002006

Smith B, Lisman RD, Simonton J, Della Rocca R. Volkmann’s contracture of the extraocular muscles following blowout fracture. Plastic Reconstructive Surgery. 1984;74:200-216. https://doi.org/10.1097/00006534-198408000-00004

Soll DB, Polley BJ. Trapdoor Variety of Blowout Fracture of the Orbital Floor. Am J Ophtalmol. 1965 Aug; 60: 269-272. https://doi.org/10.1016/0002-9394(65)90927-x

Gart MS, Gosain AK. Evidence Based Medicine: Orbital Floor Fractures. Plast Reconstr Surg. 2014 Dec; 134(6):1345-1355. https://doi.org/10.1097/prs.0000000000000719

Neinstein RM, Phillips JH, Forrest CR. Pediatric orbital floor trapdoor fractures: Outcomes and CT-based morphologic assessment of the inferior rectus muscle. J Plast Reconstr Aesthet Surg. 2012 Jul; 65(7): 869-74. https://doi.org/10.1016/j.bjps.2012.02.004

Kim J, Lee H, Chi M, Park M, Lee J, Baek S. Endoscope-Assisted Repair of Pediatric Trapdoor Fractures of the Orbital Floor: Characterization and Management. J Craniofac Surg. 2010 Jan; 21(1): 101-105. https://doi.org/10.1097/scs.0b013e3181c466e2

Sires BS, Stanley Jr RB, Wash S, Levine LM. Oculocardiac Reflex Caused by Orbital Floor Trapdoor Fracture: An Indication for Urgent Repair. Arch Ophthalmol. 1998 Jul; 116(7): 955-6.

Grant JH, Patrinely JR, Weiss AH, Kierney PC, Gruss JS. Trapdoor Fracture of the Orbit in a Pediatric Population. Plast Reconstr Surg. 2002 Feb; 109(2): 482- 9. https://doi.org/10.1097/00006534-200202000-00011

Gerbino G, Roccia F, Bianchi FA, Zavattero E. Surgical Management of Orbital Trapdoor Fracture in a Pediatric Population. J Oral Maxillofac Surg. 2010 Jun; 68(6): 1310-6. https://doi.org/10.1016/j.joms.2009.12.037

Yang JW; Woo JE; An JH. Surgical outcomes of orbital trapdoor fracture in chidden and adolescents. J Craniomaxillofac Surg. 2015 May; 43(4): 444-7. https://doi.org/10.1016/j.jcms.2015.01.010

Heggie AA, Vujcich NJ, Shand JM, Bordbar P. Isolated orbital floor fractures in the paediatric patient: case series and review of management. Int J Oral Maxillofac Surg. 2015 Oct; 44(10): 1250-4. https://doi.org/10.1016/j.ijom.2015.02.019

Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli E. Intervention Within Days for Some Orbital Floor Fractures: The White-Eyed Blowout. Ophtalmic Plastic Reconstr Surg. 1998 Nov; 14(6): 379-90. https://doi.org/10.1097/00002341-199811000-00001

Bansagi ZC, Meyer DR. Internal Orbital Fractures in the Pediatric Age Group. Ophthalmology. 2000 May; 107(5): 829-36. https://doi.org/10.1016/s0161-6420(00)00015-4

Criden MR, Ellis FJ. Linear nondisplaced orbital fractures with muscle entrapment.J AAPOS. 2007 Apr;11(2): 142-148. https://doi.org/10.1016/j.jaapos.2006.08.022

Kum C, McChulley TJ, Yoon MK, Hwang TN. Adult Orbital Trapdoor Fracture. Ophtalmic Plastic Reconstr Surg. Nov-Dec 2009; 25(6):486-487. https://doi.org/10.1097/iop.0b013e3181b80e95

Jackson BF. Orbital Trauma, Bradycardia, and Vomiting: Trapdoor Fracture and the Oculocardiac Reflex. Pediatr Emerg Care. 2010 Feb;26(2): 143-5. https://doi.org/10.1097/pec.0b013e3181ce30d8

Ethunandan M, Evans BT. Linear trapdoor or “white-eye” blowout fracture of the orbit: not restricted to children. Br J Oral Maxillofac Surg. 2011 Mar; 49(2):142-7. https://doi.org/10.1016/j.bjoms.2010.03.012

Noh WJ, Park TJ, Kim JY, Kwon JH. Isolated trapdoor-type medial blowout fracture in an adult presenting horizontal diplopia treated by endoscopic endonasal approach. J Surg Case Rep. 2013 Mar 5; 2013 (3): rjt009. https://doi.org/10.1093/jscr/rjt009

Hink EM, Wei LA, Durairaj VD. Clinical Features and Treatment of Pediatric Orbit Fractures. Ophtalmic Plast Reconstr Surg. Mar-Apr 2014; 30(2): 124-31. https://doi.org/10.1097/iop.0000000000000026

Yew CC, Shaari R, Rahman SA, Alam MK. White-eyed blowout fracture: Diagnostic pitfalls and review of literature. Injury. 2015 Sep;46(9): 1856-9. https://doi.org/10.1016/j.injury.2015.04.025

Abumanhal M, Ben-Canaan R, Feldman I, Keren S, Leibovithch I. Polyster Urethane Implants for Orbital Trapdoor Fractures Repair in Children. J Oral Maxillofac Surg. 2019 Jan; 77(1): 126-131. https://doi.org/10.1016/j.joms.2018.08.005

Karthik R, Cynthia S, Vivek N, Saravanan C, Prashanthi G. Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures. J Oral Maxillofac Surg. 2019 Jun;77(6):1229.e1-1229.e8. https://doi.org/10.1016/j.joms.2019.02.033

Prasad C, Arulmozhi M, Balaji J, Nisha MPN. White-Eyed Blowout Fracture. Ann Maxillofac Surg. Jan-Jun 2020;10(1):217-219. https://doi.org/10.4103/ams.ams_150_19

Dunphy L, Anand P. Paediatric orbital trapdoor fracture misdiagnosed as a head injury: a cautionary tale!. BMJ Case Rep. 2019 Apr 3;12(4):e228739. https://doi.org/10.1136/bcr-2018-228739

Brasileiro BF, Sickels JEV, Cunningham LL. Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis. J Korean Assoc Oral Maxillofac Surg. 2020 Dec 31;46(6):428-434. https://doi.org/10.5125/jkaoms.2020.46.6.428

Guerra RC, Pulino BFB, Mendes BC, Pereira RDS, Pinheiro FL, Hochuli-Vieira E. Orbital Trapdoor Facture in Child: More Predictable Outcomes and Less Consequences. J Craniofac Surg. Jul-Aug 2020;31(5):e469-e471. https://doi.org/10.1097/scs.0000000000006438

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2022 Costa SM et al

Metrics

Metrics Loading ...