title: Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele.
abstract: Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. They are typically associated with severe mechanisms of injury and may be associated with significant neurologic or ophthalmologic compromise including traumatic brain injury and vision loss. Rarely, traumatic encephalocele or pulsatile exophthalmos may be present at the time of injury or develop in delayed fashion, necessitating close observation of these patients. In this article, we describe two patients with minimally displaced blow-in type orbital roof fractures that were later complicated by orbital encephalocele and pulsatile exophthalmos, prompting urgent surgical intervention. We also suggest a management algorithm for adult patients with orbital roof fractures, emphasizing careful observation and interdisciplinary management involving plastic surgery, neurosurgery, and ophthalmology.
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Austin Y
authors.initials: AY
authors.lastname: Ha
authors.affiliation: Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: William
authors.initials: W
authors.lastname: Mangham
authors.affiliation: Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Frommer
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: David
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Petra
authors.initials: P
authors.lastname: Klinge
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mount Auburn Hospital, Cambridge, Massachusetts.
authors.forename: Helena O
authors.initials: HO
authors.lastname: Taylor
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Adetokunbo A
authors.initials: AA
authors.lastname: Oyelese
authors.affiliation: Division of Plastic and Reconstructive Surgery, Mount Auburn Hospital, Cambridge, Massachusetts.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Sullivan
keywords: management algorithm; orbital encephalocele; orbital roof fractures; pulsatile exophthalmos