An 11-year multicentric surgical experience on pediatric orbital floor trapdoor fracture: A World Oral Maxillofacial Trauma (WORMAT) project - 07/09/24

Doi : 10.1016/j.jormas.2024.102033

Paolo Cena ^a, Immacolata Raco ^a, Fabio Roccia ^a, Sobrero Federica ^a,^⁎ , Emil Dediol ^b, Boris Kos ^b, Gian Battista Bottini ^c, Maximilian Goetzinger ^c, Sahand Samieirad ^d, Luis Fernando de Oliveira Gorla ^e, Valfrido Antonio Pereira-Filho ^e, Petia Pechalova ^f, Angel Sapundzhiev ^f, Marko Lazíc ^g, Vitomir S. Konstantinovic ^g, Emanuele Zavattero ^a, Anamaria Sivrić ^h, Mario Kordić ^h, Sajjad Abdur Rahman ⁱ, Tabishur Rahman ⁱ, Karpal Singh Sohal ^j, Timothy Aladelusi ^k, Euan Rae ^l, Sean Laverick ^l, Aleš Vesnaver ^m, Anže Birk ^m, Constantinus Politis ⁿ, Kathia Dubron ⁿ
^a Department of Surgical Sciences, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Via Genova 3, Turin 10131, Italy
^b Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
^c Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
^d Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
^e Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, Araraquara, São Paulo, Brazil
^f Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
^g Clinic of Maxillofacial Surgery, School of dentistry, University of Belgrade, Belgrade, Serbia
^h Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
ⁱ Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
^j Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
^k Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
^l Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
^m Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
ⁿ Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 07 September 2024

Abstract

Introduction

Trapdoor fractures of the orbital floor occur almost exclusively in the paediatric population. Despite being widely discussed in the literature, their management remains controversial. The objective of this retrospective study was to analyse the surgical experiences on paediatric trapdoor fractures in the maxillofacial centres participating in the WORMAT project.

Materials and methods

14 centres collected data for patients aged ≤16 years operated between January 2011 and December 2022. The demographic, cause and type of fracture, timing from injury to surgery, surgical approach, type of floor repair and outcomes were recorded. Diplopia, surgical wound infection, hardware loosening and dysesthesia in the infraorbital nerve area were recorded at follow-up.

Results

43 patients were included: 25 children (0–12 y) and 18 adolescents (13–16 y) (mean age, 11.1 years). Surgical treatment was performed within 24 h in 51 % of the patients, within 24–72 h in 33 %, and beyond 72 h in the remaining. The orbital floor was repaired with a resorbable implant/membrane in 63 % of the patients, open reduction without an implant in 30 %, a titanium mesh implant in 3 adolescent patients. At follow-up (mean 16.3 months), 14 patients had residual diplopia in the upper fields, only two of these resolved within 6 months.

Discussion

A tendency toward an increased incidence of postoperative diplopia with longer intervals between trauma and surgery was observed. This study showed different choices regarding the material placed on the floor, with a preference for open reduction without implants in children, compared to the use of resorbable implants or membranes in adolescents.

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Keywords : Child, Adolescent, Orbit, Internal fracture fixation, Outcome, Diplopia