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J Neurol Surg B Skull Base 2022; 83(03): 281-284
DOI: 10.1055/s-0040-1721821
Original Article

Pediatric Orbital Roof Fractures: A Ratio of Orbital Dimensions Correlated to Prevalence of Fracture

Stephen C. Dryden 
1   Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Andrew G. Meador
1   Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Andrew B. Johnston
1   Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Adrianna E. Eder
1   Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
James C. Fleming
2   Department of Ophthalmology, Veterans Administration Hospital, Memphis, Tennessee, United States
,
Brian Fowler
1   Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, United States
› Author Affiliations Funding This study was supported by an unrestricted grant from Research to Prevent Blindness.
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Abstract

Objective Orbital roof fractures are more likely to occur in younger children, specifically younger than 7 years. Cranium to face ratio decreases with age; however, there is no definition for measurement of the neurocranium or face. We propose using the length of the orbital roof as a measurement of the neurocranium and length of the orbital floor as a tool to estimate midface size. The purpose of this study is to test this measurement as a correlation rate of orbital roof fractures within the pediatric population.

Design This is a retrospective study.

Setting This study was done at the LeBonheur Children's Hospital.

Participants Sixty-six patients with orbital roof fractures were identified and stratified by gender and age, specifically younger than 7 years and 7 years or older.

Main Outcome Measures The main outcome measures were orbital roof length, floor length, and ratio thereof.

Results Mean orbital roof length was 43.4 ± 3.06 and 45.1 ± 3.94 mm for patients <7 and ≥7 years, respectively (p = 0.02). Mean orbital floor length was 41.3 ± 2.99 and 47.7 ± 4.19 for patients <7 and ≥7 years, respectively (p < 0.00001). The mean roof to floor ratio (RTFR) for patients <7 years was 1.051 ± 0.039 and for patients ≥ 7 years was 0.947 ± 0.031 (p < 0.00001).

Conclusion As children age, the relative length of the orbital roof decreases when compared with the orbital floor. The RTFR was more than 1.0 in children younger than 7 years. These differences were statistically significant when compared with children 7 years and older. This measurement shift follows the differences noted in orbital fracture patterns during childhood.

Keywords

orbital roof fracture - pediatric - trauma - pediatric orbital fracture - craniofacial - skull - orbit development - measurement correlate

Note

The preliminary data was presented at 30th Annual North American Skull Base Society Meeting 2020 in San Antonio, Texas, United States.




Publication History

Received: 24 March 2020

Accepted: 25 September 2020

Article published online:
14 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. J Am Coll Surg 2008; 207 (05) 710-716
    CrossrefPubMedGoogle Scholar
  • 2 Gaw CE, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med 2016; 16: 5
    CrossrefPubMedGoogle Scholar
  • 3 Donahue DJ, Smith K, Church E, Chadduck WM. Intracranial neurological injuries associated with orbital fracture. Pediatr Neurosurg 1997; 26 (05) 261-268
    CrossrefPubMedGoogle Scholar
  • 4 Gerber B, Kiwanuka P, Dhariwal D. Orbital fractures in children: a review of outcomes. Br J Oral Maxillofac Surg 2013; 51 (08) 789-793
    CrossrefPubMedGoogle Scholar
  • 5 Singh V, Sasidharan GM, Bhat DI, Devi BI. Growing skull fracture and the orbitocranial variant: nuances of surgical management. Pediatr Neurosurg 2017; 52 (03) 161-167
    CrossrefPubMedGoogle Scholar
  • 6 Mohindra S, Mukherjee KK, Chhabra R, Gupta R. Orbital roof growing fractures: a report of four cases and literature review. Br J Neurosurg 2006; 20 (06) 420-423
    CrossrefPubMedGoogle Scholar
  • 7 Hink EM, Wei LA, Durairaj VD. Clinical features and treatment of pediatric orbit fractures. Ophthal Plast Reconstr Surg 2014; 30 (02) 124-131
    CrossrefPubMedGoogle Scholar
  • 8 Fulcher TP, Sullivan TJ. Orbital roof fractures: management of ophthalmic complications. Ophthal Plast Reconstr Surg 2003; 19 (05) 359-363
    CrossrefPubMedGoogle Scholar
  • 9 Koltai PJ, Amjad I, Meyer D, Feustel PJ. Orbital fractures in children. Arch Otolaryngol Head Neck Surg 1995; 121 (12) 1375-1379
    CrossrefPubMedGoogle Scholar
  • 10 Kozak FK, Lesperance M, Flint P. Characteristics of normal and abnormal postnatal craniofacial growth and development. In: Cummings Pediatric Otolaryngology. Philadelphia, PA: Elsevier; 2014: 55-80
    Google Scholar
  • 11 Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin North Am 2012; 24 (04) 525-536
    CrossrefPubMedGoogle Scholar
  • 12 Messinger A, Radkowski MA, Greenwald MJ, Pensler JM. Orbital roof fractures in the pediatric population. Plast Reconstr Surg 1989; 84 (02) 213-216 , discussion 217–218
    CrossrefPubMedGoogle Scholar
  • 13 Cossman JP, Morrison CS, Taylor HO, Salter AB, Klinge PM, Sullivan SR. Traumatic orbital roof fractures: interdisciplinary evaluation and management. Plast Reconstr Surg 2014; 133 (03) 335e-343e
    CrossrefPubMedGoogle Scholar