Złamania oczodołu u dzieci
Orbital Fractures in Children
Mirosława Grałek, Anna Niwald, Beata Orawiec
Klinika Okulistyki Dziecięcej Katedry Pediatrii Zabiegowej Uniwersytetu Medycznego w Łodzi
Samodzielny Publiczny Zespół Opieki Zdrowotnej, Uniwersytecki Szpital Kliniczny nr 4 Uniwersytetu Medycznego w Łodzi
Kierownik: dr hab. n. med. Anna Niwald
Summary: This paper presents a review of current knowledge on orbital fractures in children. In case of children these fractures occur rarely. The type and incidence of orbital fractures is associated with children’s age. Clinical pictures of orbital fracture include restricted extraocular motility and diplopia. Eye injures are observed in children with orbital fractures, ranging from mild injury (palpebral and subconjunctival hemorrhages) to severe injury (eye globe, intracranial, traumatic optic neuropathy). They often present nausea and vomiting. The most commonly fractured area is the orbital floor, followed by the combination of orbital floor and medial wall and isolated medial wall of the orbit. The medial orbital wall may occasionaly be fractured as well. The orbital roof fractures are rare. Blow-out fractures include any internal orbital wall fracture without involvement of the rim but usually refers to the floor and medial wall with one or more soft tissue structures entrapment. Blow-out fracture in young children are not very common. It is probably due to anatomy differences, as the preadolescent children present craniofacial disproportion with under development midface, small size of the maxillary sinuses, and protrudred cranium and mandibule. There are two dominant theories of blow-out trauma: “hydraulic” mechanism and “buckling” mechanism. Isolated orbital floor fractures are the results of blunt facial trauma. The cause of blow-out fracture may be sport injury, assault, falls, and car and motor wehicle accident. Pediatric orbital roof fractures are result of falls and motor vehicle accidens. Clinical picture of orbital fracture includes: symptoms of oculocardiac reflex, restricted extraocular motility, diplopia, enophthalmos, vertical dystopia, cerebrospinal fluid leak, injures of the central nervous system. Imaging examination is necessary to obtain proper diagnosis. The treatment of orbital fractures needs to be adapted to the degree of injury and clinical sympotoms present. Surgery or observation is the main magament. Reconstruction of an orbital wall is performed using autogenous and allogenic materials. Cooperation between ophthalmology, neurosurgery and head and neck surgeon are essential to optimize care for children with orbital fracures.
Słowa kluczowe: dzieci, złamanie oczodołu, złamanie rozprężające oczodołu, wkleszczenie mięśni, ograniczenie ruchomości gałki, dwojenie, złamanie stropu oczodołu.
Keywords: children, orbital fracture, blow-out fracture of the orbit, muscles entrapment, limit ocular motility, diplopia, orbital roof fractures.