Department of Otorhinolaryngology, Head & Neck Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
J Craniofac Surg. 2023 May 1;34(3):976-978. doi: 10.1097/SCS.0000000000009163. Epub 2023 Jan 9.
Orbital trapdoor fractures in children and adolescents can cause persistent problems with vision and appearance. Early surgery is recommended, although, because of the rarity of these fractures, there is a lack of evidence regarding the optimal timing of surgery.The objective of this study was to examine the effect of the time from trauma to surgery on the recovery time and severity of diplopia in children and adolescents with orbital trapdoor fractures.
A retrospective cohort study was performed of all orbital fractures in children and adolescents aged 0 to 20 years, treated at a tertiary referral center in 2005-2017. Data relating to demographics, cause of injury, surgery, time of follow-up, and final outcomes were extracted. The cases of trapdoor fracture were specifically examined with regard to the time from trauma to surgery and diplopia at last follow-up, which was the primary outcome.
One hundred thirty-five patients, aged 2.4 to 20 years (mean 17.0), were treated for orbital fractures during the period; 37 (27%) had an isolated orbital floor fracture and 12 (9%) had a trapdoor fracture. All patients with trapdoor fractures underwent surgery; the mean time to surgery was 11.9 days in 2007-2011 and 1.1 days in 2012-2017. Although statistical significance cannot be proven in this small and retrospective study, a shorter time from trauma to surgery seems to lead to fewer problems with diplopia and 2 patient cases that highlight this are presented.
Delayed surgical intervention in pediatric orbital trapdoor fractures increases the risk of delayed recovery and persistent diplopia. Other factors, such as the degree of muscle incarceration and necrosis and the surgeon's experience and skill, may, however, also influence the outcomes.
儿童和青少年的眼眶活瓣骨折可导致视力和外观持续存在问题。尽管如此，由于这些骨折罕见，因此缺乏关于手术最佳时机的证据，建议早期手术。本研究的目的是研究从创伤到手术的时间对儿童和青少年眼眶活瓣骨折患者复视恢复时间和严重程度的影响。
对 2005 年至 2017 年在一家三级转诊中心治疗的 0 至 20 岁儿童和青少年的所有眼眶骨折进行了回顾性队列研究。提取了与人口统计学、损伤原因、手术、随访时间和最终结果相关的数据。特别对活瓣骨折的病例进行了检查，重点是从创伤到手术的时间以及最后随访时的复视，这是主要结果。
在此期间，135 名年龄为 2.4 至 20 岁（平均 17.0 岁）的患者因眼眶骨折接受治疗；37 例（27%）为单纯眶底骨折，12 例（9%）为活瓣骨折。所有活瓣骨折患者均接受了手术；2007-2011 年的平均手术时间为 11.9 天，2012-2017 年为 1.1 天。尽管在这项小型回顾性研究中无法证明统计学意义，但从创伤到手术的时间越短，复视问题越少，并且提出了 2 个突出这一点的患者病例。
儿童眼眶活瓣骨折的手术干预延迟会增加延迟恢复和持续性复视的风险。然而，其他因素，如肌肉嵌顿和坏死的程度以及外科医生的经验和技能，也可能影响结果。
