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Outcomes and Prognostic Factors in Pediatric Orbital Trapdoor Fracture: A Multi-Center Study Publisher Pubmed



Eshraghi B1 ; Khademi B2 ; Rafizadeh SM3 ; Noorshargh P1 ; Attar A2 ; Shahsavari A1 ; Ghorbani S1
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Authors Affiliations
  1. 1. Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Ophthalmology, Poostchi ophthalmology research center, school of medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  3. 3. Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran

Source: Oral and Maxillofacial Surgery Published:2025


Abstract

Purpose: To evaluate clinical presentations, computed tomography (CT) findings, and various prognostic factors affecting the surgical outcomes of trapdoor fractures. Methods: This retrospective multi-center study reviewed medical records and orbital CT scans of patients under 21 years old, diagnosed with isolated trapdoor fractures. The study was conducted across multiple medical centers, including emergency and clinical departments in Isfahan, Shiraz, and Tehran-Iran. The characteristics and outcomes following surgical intervention were assessed. Results: 45 patients with isolated trapdoor fractures were included in the study, with a mean age of 11.67 ± 4.69 years, predominantly male (84.4%). Vehicle accidents was the major cause of fractures (31.1%). 44 patients (97.8%) had orbital floor fracture, and one patient (2.2%) had medial wall involvement. Nausea/vomiting were reported in 41 patients (91.1%). Surgical intervention within 2 days, resulted in 85.0% of patients experiencing no postoperative diplopia. Delayed surgery beyond 2 days showed increased odds of diplopia, although not statistically significant. CT scan findings suggested a lower risk of diplopia in patients with soft tissue entrapment compared to muscle involvement (OR: 0.336, 95% CI: 0.077–1.462, p = 0.146). Shorter time to surgery (within 2 days) was significantly associated with normal postoperative eye movements (p = 0.002). Nausea/vomiting were more prevalent in patients with muscle entrapment (p < 0.05). Conclusion: Surgical intervention within 48 h is crucial for improving ocular motility following trapdoor fractures. Extraocular symptoms, including nausea/vomiting, should raise suspicion for trapdoor fractures in cases of orbital trauma associated with ocular movement impairment. Clinical trial number: Not applicable. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.