Towards a differential diagnosis of orbital blowout fractures in children

     Towards a differential diagnosis of orbital blowout fractures in children N.A. Malinovskaya1, R.L. Troyanovsky2, V.V. Stepanov1, Y.Y. Prilutskykh1 1Department of Ophthalmology C.A. Rauchfus Children's hospital № 19, St.Peterburg 2Department of Ophthalmology, Military Medical Academy S.M. Kirov, St.Peterburg

    Purpose. To evaluate the features of clinical symptoms, differential diagnosis and surgical treatment of orbital blowout fractures in children.

    Material and methods. The clinical course, anatomic features and results of treatment were analyzed in 132 patients (106 boys — 80.3% and 26 girls — 19.7%) aged from 5 to 18 years. Four patients had post-traumatic Brown's syndrome. All patients underwent computer tomography (CT scans). Operations were performed in 83 patients (62.88%) with fracture of orbital floor and in 4 patients (3.03%) with fracture of medial wall. There were no surgeries in 45 patients (34.09%).

    Results. In four patients post-traumatic Brown's syndrome was diagnosed instead of suspected orbit fracture. In another four cases orbital fracture was not revealed according to CT data, but the surgical procedure found a bone defect with inferior rectus muscle incarceration. Indications for surgical treatment in various forms of inferior rectus muscle incarceration were evaluated.

    Full and functionally favorable results after timely surgical treatment were obtained in 90% of cases.

    Conclusions. The critical analysis of oculomotor muscle function disorders and CT images were extremely important for timely proper diagnosis of orbital contusion injury, especially in cases with a complete strangulation of inferior rectus muscle in the fracture area, where the surgery should be carried out early enough (within the first week after injury) to prevent a posttraumatic paresis.

    Keywords: orbital blowout fractures, Brown's syndrome, surgical treatment, computer tomography (CT scans).