title: Underestimation of soft tissue entrapment by computed tomography in orbital floor fractures in the pediatric population.
abstract: OBJECTIVE
  To compare the timing, radiologic, and clinical indications for surgical management of orbital floor fractures in the pediatric and adult populations.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Twenty-four pediatric and 31 adult patients who underwent primary repair of an orbital floor fracture.
  
  
  METHODS
  The records of all patients presenting to the oculoplastics service for primary repair of orbital floor fracture over an 8-year period were reviewed.
  
  
  METHODS
  Time to surgical intervention, clinical indication for surgery, radiologic evidence, and intraoperative findings of entrapment.
  
  
  RESULTS
  Pediatric orbital floor fractures were repaired an average of 3 weeks earlier than adult fractures. The most common clinical indication for surgery was entrapment in the pediatric group versus enophthalmia in the adult group. There was a significant underestimation of entrapment reported on computed tomography (CT) in the pediatric group when compared with the clinical indications and intraoperative findings. Conversely, there was good concordance between radiologic and intraoperative findings in the adult group.
  
  
  CONCLUSIONS
  Pediatric orbital floor fractures are often of the trapdoor type, which require earlier surgical intervention. Entrapment and incarceration of orbital soft tissue contents as imaged by CT can be missed by radiologists. Our study demonstrates the poor concordance between radiologic and intraoperative evidence for entrapment in the pediatric population. It is important for the clinician to review all radiologic studies and to perform a thorough ophthalmologic evaluation to aid with clinical decision making.
authors.affiliation: Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA.
authors.forename: Keshini C
authors.initials: KC
authors.lastname: Parbhu
authors.forename: KoriAnne E
authors.initials: KE
authors.lastname: Galler
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.forename: Louise A
authors.initials: LA
authors.lastname: Mawn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015841:Enophthalmos / Q000000981:diagnostic imaging*; D005131:Eye Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging* / Q000293:injuries*; D009917:Orbital Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed