Posttraumatic subperiosteal hematomas of the orbit in children.
OBJECTIVE
To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature.


METHODS
Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature.


RESULTS
Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage.


CONCLUSIONS
In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.
Yazici
Bülent
B
Department of Ophthalmology, Uludag University, Bursa, Turkey. byazici@uludag.edu.tr
Gönen
Tansu
T
D000293:Adolescent; D002648:Child; D005131:Eye Injuries / Q000150:complications*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009915:Orbit / Q000293:injuries*; D010521:Periosteum; D019315:Retrobulbar Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D014949:Wounds, Nonpenetrating / Q000150:complications*