Subscribe to RSS
Pediatric Orbital Roof Fractures: A Ratio of Orbital Dimensions Correlated to Prevalence of FractureFunding This study was supported by an unrestricted grant from Research to Prevent Blindness.
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.
Keywordsorbital roof fracture - pediatric - trauma - pediatric orbital fracture - craniofacial - skull - orbit development - measurement correlate
The preliminary data was presented at 30th Annual North American Skull Base Society Meeting 2020 in San Antonio, Texas, United States.
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
- 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
- 2 Gaw CE, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med 2016; 16: 5
- 3 Donahue DJ, Smith K, Church E, Chadduck WM. Intracranial neurological injuries associated with orbital fracture. Pediatr Neurosurg 1997; 26 (05) 261-268
- 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
- 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
- 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
- 7 Hink EM, Wei LA, Durairaj VD. Clinical features and treatment of pediatric orbit fractures. Ophthal Plast Reconstr Surg 2014; 30 (02) 124-131
- 8 Fulcher TP, Sullivan TJ. Orbital roof fractures: management of ophthalmic complications. Ophthal Plast Reconstr Surg 2003; 19 (05) 359-363
- 9 Koltai PJ, Amjad I, Meyer D, Feustel PJ. Orbital fractures in children. Arch Otolaryngol Head Neck Surg 1995; 121 (12) 1375-1379
- 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
- 11 Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin North Am 2012; 24 (04) 525-536
- 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
- 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