Surgical management of orbital wall fractures in juveniles: a European multicenter study

Introduction Isolated orbital floor fractures in juveniles are a challenge, as children and adolescents may experience diplopia and limited ocular motility, even with little to no periorbital edema or visible signs of injury to the eye. The aim of the present study is to assess the demographic and clinical variables, and the outcomes of pediatric patients affected by isolated orbital wall fractures at several European oral and maxillofacial surgery centers. Methods Pediatric patients (less than 18 years) with hospitalized and surgically treated for unilateral isolated orbital blow out fractures of the orbital floor and/or the medial wall were included. The following data were recorded for each patient: gender, age, etiology of trauma, site of orbital wall fracture(s), timing of intervention, surgical approach, orbital reconstruction material/implant, post-operative complications Results A total of 51 pediatric patients (45 boys, 6 girls) with a mean age of 12.1 years were included. Most patients (43 children, 84.3%) presented with an isolated orbital floor fracture. Clinically, the most frequently observed sign was diplopia / double vision (43 patients, 84.3%). More than two thirds (68.6%) of cases were surgically treated within the first two days from injury. In 6 patients (11.8%) one or more persistent postoperative disturbances were found six months postoperatively, including diplopia in 3 subjects (5.9%), infraorbital nerve paresthesia in 2 patients (3.9%), and enophthalmos in 2 patients (3.9%). Conclusions The rarity of pure orbital wall fractures in pediatric patients makes it difficult to establish uniform evidence-based guidelines for their management. These injuries must also be recognized promptly, as surgical intervention may be required at a very early stage. A reasoned and individualized choice of the optimal surgical approach appears to be the most appropriate strategy for this specific type of facial fracture in the pediatric population. Clinical trial number Not applicable.