Firriolo Joseph M, Ontiveros Nicole C, Pike Carolyn M, Taghinia Amir H, Rogers-Vizena Carolyn R, Ganor Oren, Greene Arin K, Meara John G, Labow Brian I
Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
J Craniofac Surg. 2017 Nov;28(8):1966-1971. doi: 10.1097/SCS.0000000000004017.
Orbital floor fractures can produce acute constitutional symptoms and poor ocular outcomes. This study aims to determine the clinical and radiological predictors of tissue entrapment in pediatric orbital floor fractures and to explore the effect of operative timing on ocular outcomes. The authors reviewed medical records from pediatric patients with orbital floor fractures from 2007 to 2015. One hundred fifty-two patients with 159 orbital floor fractures were included. One hundred twenty-two (80.3%) patients were male, and the mean age was 12.2 years. Twelve patients sustained orbital floor fractures with tissue entrapment. At presentation extraocular movement (EOM) restriction, diplopia, nausea, and vomiting were all associated with tissue entrapment (P < 0.001). Among patients with trapdoor fractures (determined by facial computed tomography), the presence of nausea and/or vomiting was predictive of tissue entrapment: positive predictive value 80%, negative predictive value 100%. For all the patients, regardless of fracture configuration, the presence of nausea and/or vomiting was valuable in ruling out tissue entrapment: sensitivity 83.3%, negative predictive value 98.1%. In tissue entrapment patients, poorer ocular outcomes (EOM restriction and diplopia) were associated with the length of operation (P = 0.007), but not the time interval to operation (P = 0.146). The authors conclude that nausea and vomiting are valuable predictors of tissues entrapment, particularly when EOM restriction and diplopia are equivocal. In the authors' study, radiological findings were also predictive of entrapment, but inconsistent language in this area limits the external validity of these results. The authors' study draws attention to the relationship between operation length and poorer ocular outcomes, suggesting that case severity/complexity and surgeon technique/experience may influence outcomes.
眶底骨折可导致急性全身症状和不良的眼部预后。本研究旨在确定小儿眶底骨折中组织嵌顿的临床和影像学预测因素，并探讨手术时机对眼部预后的影响。作者回顾了2007年至2015年小儿眶底骨折患者的病历。纳入了152例患者的159处眶底骨折。122例（80.3%）患者为男性，平均年龄为12.2岁。12例患者发生眶底骨折伴组织嵌顿。就诊时，眼球运动（EOM）受限、复视、恶心和呕吐均与组织嵌顿相关（P<0.001）。在伴有活板门骨折（由面部计算机断层扫描确定）的患者中，恶心和/或呕吐的存在可预测组织嵌顿：阳性预测值为80%，阴性预测值为100%。对于所有患者，无论骨折类型如何恶心和/或呕吐的存在对于排除组织嵌顿很有价值：敏感性为83.3%，阴性预测值为98.1%。在组织嵌顿患者中，较差的眼部预后（EOM受限和复视）与手术时间长短相关（P=0.007），但与手术间隔时间无关（P=0.146）。作者得出结论，恶心和呕吐是组织嵌顿的重要预测因素，尤其是当EOM受限和复视不明确时。在作者的研究中，影像学检查结果也可预测嵌顿情况，但该领域的表述不一致限制了这些结果的外部有效性。作者的研究提请注意手术时间长短与较差眼部预后之间的关系，表明病例的严重程度/复杂性以及外科医生的技术/经验可能会影响预后。
