J Korean Ophthalmol Soc.  2016 Jan;57(1):120-124. 10.3341/jkos.2016.57.1.120.

Osteoneogenesis on Subperiosteal Orbital Hematoma in a 10-Year-Old Boy

• Son DY
• Woo KI

• KMID: 2213856
• DOI: http://doi.org/10.3341/jkos.2016.57.1.120

Abstract

PURPOSE
We report the first case in Korea of rapid bone formation on a subperiosteal orbital hematoma after trauma.
CASE SUMMARY
A 10-year-old boy who was in the intensive care unit after trauma showed proptosis and ocular movement limitation of the right eye associated with subperiosteal hematoma. On ocular examination, 3 mm of proptosis and limitation of right eye movement were observed; however, visual acuity was not decreased. At 1 month after the trauma, orbital computed tomography (CT) showed new bone formation at the margin of the hematoma border although the size of the hematoma decreased. The patient underwent hematoma and bony tissue removal using anterior orbitotomy approach. A new bone was formed between the orbital border and hematoma from the anterior orbital margin to the orbital apex. During pathological examination, woven bone tissue with fibrotic tissue was observed in the hematoma wall. One year after surgery, the patient's proptosis and limitation of ocular movement disappeared without any evidence of new bone formation.
CONCLUSIONS
Waiting for spontaneous absorption of orbital subperiosteal hematoma is usually recommended unless there is significant functional impairment. However, as in our case, new bone formation could occur during a short period of less than 1 month; imaging follow-up is necessary in patients having intensive care or showing delayed absorption of a hematoma.

Keyword

Orbital subperiosteal hematoma; Osteoneogenesis

MeSH Terms

Absorption
Bone and Bones
Child*
Exophthalmos
Eye Movements
Follow-Up Studies
Hematoma*
Humans
Critical Care
Intensive Care Units
Korea
Male*
Orbit*
Osteogenesis
Visual Acuity

Figure

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  Figure 1. Clinical photographs of the patients eyelids. The photographs shows hypoglobus (A) and exophthalmos (B) of the right eye.

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  Figure 2. Orbit magnetic resonance imaging (MRI) taken 9 days after trauma. These pictures show subacute stage of hematoma. T1-weighted axial images (A) and coronal images (B) after gadolinium enhancement with fat suppression reveal a soft tissue mass at the superior portion of right orbit (arrows). Mass shows a high signal intensity on T1-weighted sagittal image with enhancement (C, arrow) and low and high signal intensity on T2-weighted axial image (D, arrow).

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  Figure 3. Orbit CT taken at 2 weeks after trauma. Convex-shap-ed mass lesion with fine spots of calcifications at the superior or-bit (arrow). CT = computed tomography

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  Figure 4. Orbit CT taken at 4 weeks after trauma. A convex le-sion was slightly decreased, but it accompanies a clear-cut cal-cification line at the inferior margin, in the coronal (A, arrow) and sagittal (B, arrow) CT scans. CT = computed tomography.

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  Figure 5. Histological examination. Calcification foci are denoted in the collagen fibril background (A: H&E stain, ×40). Immature bony matrix lined with osteoblasts and osteoclasts was consistent with findings of woven bone (B: H&E stain, ×400).

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  Figure 6. Orbit CT scan taken at 1month after surgery. Hematoma and calcific wall was not observed at coronal CT scan. CT = computed tomography.

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