Surgical Intervention on Pediatric Orbital Floor Fractures Improves - - PowerPoint PPT Presentation

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Surgical Intervention on Pediatric Orbital Floor Fractures Improves - - PowerPoint PPT Presentation

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Surgical Intervention on Pediatric Orbital Floor Fractures Improves Enophthalmos but Does Not Affect Visual Outcomes: An Analysis of 72 Children with Isolated Orbital Floor Fractures Justin M. Broyles, MD, Danielle Jones, BS, Justin Bellamy, BS,

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October 5, 2014 1

Surgical Intervention on Pediatric Orbital Floor Fractures Improves Enophthalmos but Does Not Affect Visual Outcomes: An Analysis of 72 Children with Isolated Orbital Floor Fractures

Justin M. Broyles, MD, Danielle Jones, BS, Justin Bellamy, BS, Mohamad Sebai, MD, Sami Tuffaha, MD, Karim Sarhane, MD, Paul N. Manson, MD, Amir H. Dorafshar, MBChB The Johns Hopkins Hospital Department of Plastic and Reconstructive Surgery Baltimore, MD

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Nothing to disclose

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BACKGROUND

  • Pediatric facial fractures are common
  • Periorbital fractures are the third most common

facial fracture1

  • Established algorithms for adult orbital floor

fracture management

  • Management of pediatric floor fractures is

controversial

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  • 1. Gerber, Barbara, Paul Kiwanuka, and Daljit Dhariwal. "Orbital Fractures in Children: A Review of Outcomes." British Journal of Oral and

Maxillofacial Surgery 51.8 (2013): 789-93

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BACKGROUND

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Figure from:Alcala-Galiano, A., I. J. Arribas-Garcia, M. A. et al.. "Pediatric Facial Fractures: Children Are Not Just Small Adults." Radiographics 28.2 (2008): 441-61.

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CLINICAL PRESENTATIONS

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Wei, Leslie A, et al, "Pediatric Orbital Floor Fractures." Journal of American Association for Pediatric Ophthalmology and Strabismus 15.2 (2011): 173-80.

Restricted Upward Gaze Enophthalmos

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PURPOSE

  • Aims:

– Determine defect/orbit width ratio that is associated with the development enophthalmos – Predict long-term visual outcomes in children who present with visual disturbances

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METHODS

  • Retrospective review, 1991-2012
  • 72 Children with isolated orbital floor fractures
  • 76 Fractures
  • Chart and radiographic review

– Panoramic radiographs (66%) – Computed tomography (34%)

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RADIOGRAPHIC EVALUATION

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DEMOGRAPHICS

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69% (50/72) MALE AGE: 8.4 YRS +/- 4YRS FOLLOW-UP: 14 MONTHS

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RESULTS: MANAGEMENT

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P<0.05 SURGERY CONSERVATIV E Defect Width (mm) 20.7 7.8 Defect/Orbit Width ratio 0.54 0.32

  • 33% Treated surgically
  • Surgical indications:

– Size of fracture (65%) – Entrapment (17%)

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RESULTS: VISUAL ACUITY

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PRESENTATION Visual Acuity:

– 19% Decreased (14/72) – 81% Unchanged (58/72)

FOLLOW-UP Visual Acuity:

– Unchanged 50% (7/14) – Decreased 7% (1/14) – Improved 43% (6/14)

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RESULTS: ENOPHTHALMOS

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ON ADMISSION

  • 8% (6/72)

– 4 Managed surgically

  • Complete resolution

– 2 Managed conservatively

  • Complete resolution

AT FOLLOW-UP

  • 4% (3/72)

– Managed conservatively

  • Complete resolution
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RESULTS: SURGICAL OUTCOMES

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ENOPHTHALMOS IMPROVEMENT VISUAL ACUITY SURGERY RR: 0.02 CI 0-0.49, p<0.05 NS

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CONCLUSIONS

  • Surgical correction of floor defects eliminates

enophthalmos

  • However, enophthalmos, either acute or delayed,

can potentially resolve without surgery

  • Surgery does not improve visual acuity in patients

presenting with decreased vision

  • A definite defect/orbital width ratio for surgical

intervention remains to be determined

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