title: Pediatric orbital floor fracture : direct extraocular muscle involvement.
abstract: OBJECTIVE
  To study the clinical presentation, operative findings, and postoperative results of a surgical series of isolated orbital floor fractures in children.
  
  
  METHODS
  Noncomparative, retrospective, consecutive case series.
  
  
  METHODS
  Thirty-four patients (34 orbits) less than 18 years of age with isolated orbital floor fractures. Indications for surgery were severe limitation of extraocular ductions, 22 of 34; enophthalmos, 8 of 34: or both, 4 of 34.
  
  
  METHODS
  Surgical repair.
  
  
  METHODS
  Cause of fracture, symptoms, clinical signs, radiographic data, operative findings, postoperative results, and complications.
  
  
  RESULTS
  Children older than 12 years of age were more likely to sustain an orbital floor fracture as a result of interpersonal violence than were children less than 12 years of age (P: = 0.020). Sixty-two percent of patients (21 of 34) exhibited pain with eye movements and/or nausea and vomiting. Most had a trapdoor type fracture (21 of 34). The inferior rectus muscle was entrapped in the orbital floor fracture in 69% (18 of 26) of patients with a severe limitation of ocular ductions. Preoperative nausea and vomiting were immediately relieved after surgery. The median time for improvement of preoperative duction deficits and diplopia was 4 days for patients receiving surgery within 7 days and 10.5 days for those undergoing surgery after 14 days (P: = 0.030). Resolution of duction deficits or diplopia was not dependent on time of surgery if performed within 1 month of injury. Loss of vision, worsening of motility, or implant complications did not occur.
  
  
  CONCLUSIONS
  Pediatric patients with isolated orbital floor fractures who had pain, nausea, vomiting, and severe limitation of extraocular motility often have direct entrapment of the inferior rectus muscle into the fracture site. Surgical repair rapidly relieved preoperative pain, nausea, and vomiting. For patients with severe limitation of ductions, early surgical repair within 7 days of injury resulted in more rapid improvement of ductions and diplopia than surgery performed later.
authors.affiliation: University of Minnesota, Department of Ophthalmology, Minneapolis, Minnesota 55455-0501, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Egbert
authors.forename: K
authors.initials: K
authors.lastname: May
authors.forename: R C
authors.initials: RC
authors.lastname: Kersten
authors.forename: D R
authors.initials: DR
authors.lastname: Kulwin
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005131:Eye Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000175:diagnosis / Q000209:etiology; D015835:Ocular Motility Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000293:injuries*; D009915:Orbit / Q000000981:diagnostic imaging / Q000293:injuries*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014754:Violence; D014839:Vomiting / Q000175:diagnosis / Q000209:etiology