Arch Craniofac Surg.  2017 Jun;18(2):128-131. 10.7181/acfs.2017.18.2.128.

Pediatric Orbital Medial Wall Trapdoor Fracture with Normal Computed Tomography Findings

• Lee HR
• Jung GY
• Lee DL
• Shin HK

• KMID: 2384571
• DOI: http://doi.org/10.7181/acfs.2017.18.2.128

Abstract

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.

Keyword

Orbital fractures; Diplopia; Pediatrics

MeSH Terms

Child
Compliance
Diplopia
Dizziness
Emergency Service, Hospital
Eyebrows
Follow-Up Studies
Humans
Lacerations
Male
Nausea
Orbit*
Orbital Fractures
Pediatrics
Physical Examination
Technology, Radiologic