[Skip to Content]
[Skip to Content Landing]
December 1995

Orbital Fractures in Children

Author Affiliations

From the Section of Pediatric Otolaryngology (Drs Koltai and Amjad) and the Departments of Surgery (Dr Feustel) and Ophthalmology (Dr Meyer), Albany (NY) Medical College.

Arch Otolaryngol Head Neck Surg. 1995;121(12):1375-1379. doi:10.1001/archotol.1995.01890120033006

Objective:  To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium.

Design:  Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures.

Setting:  The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center.

Outcome measures:  The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992.

Results:  Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8±3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0±4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1± 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger.

Conclusions:  Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses.(Arch Otolaryngol Head Neck Surg. 1995;121:1375-1379)

Koltai PJ.  Maxillofacial injuries in children . In Smith JD, Bumstead R, eds.  Pediatric Facial Plastic and Reconstructive Surgery . New York, NY: Raven Press; 1993:283-316.
Rowe NL.  Fracture of the facial skeleton in children .  J Oral Surg . 1967;26: 505-515.
Kaban LB.  Diagnosis and treatment of fractures of the facial bones in children 1943-1993 .  J Oral Maxillofac Surg . 1993;51:722-729.Crossref
Gussack GS, Lutterman A, Rodgers K, Powell RW, Ramenofsky ML.  Pediatric maxillofacial trauma: unique features in diagnosis and treatment .  Laryngoscope . 1987;97:925-930.Crossref
Fortunato MA, Fielding AF, Gurensey LH.  Facial bone fractures in children .  Oral Surg Oral Med Oral Pathol . 1982;53:225-231.Crossref
McGraw BL, Cole RR.  Pediatric maxillofacial trauma .  Arch Otolaryngol Head Neck Surg . 1990;116:41-45.Crossref
Hall RK.  Injuries of the face and jaws in children .  Int J Oral Surg . 1972;1:65-75.Crossref
Kaban LB, Mulliken JB, Murray JE.  Facial fractures in children: an analysis of 122 fractures in 109 patients .  Plast Reconstr Surg . 1977;59:15-20.Crossref
Posnick JC, Wells M, Pron GE.  Pediatric facial fractures: evolving patterns of treatment .  J Oral Maxillofac Surg . 1993;51:836-844.Crossref
Thaller SR, Huang V.  Midfacial fractures in the pediatric population .  Ann Plast Surg . 1992;29:348-352.Crossref
Messinger A, Radkowski MA, Greenwald MJ, Pensler JM.  Orbital roof fractures in the pediatric population .  Plast Reconstr Surg . 1989;84:213-216.Crossref
Gruss JS.  Orbital roof fractures in the pediatric population .  Plast Reconstr Surg . 1989;84:217-218.Crossref
Antonyshyn O, Gruss JS, Kassel EE.  Blow-in fractures of the orbit .  Plast Reconstr Surg . 1989;84:10-20.Crossref
Kulwin DR, Leadbetter MG.  Orbital rim trauma causing a blow-out fracture .  Plast Reconstr Surg . 1984;66:969-970.Crossref
Raflo TG.  Blow-in and blow-out fractures of the orbit: clinical correlations and proposed mechanisms .  Ophthalmic Surg . 1984;15:114-119.
Smith B, Regan WF.  Blow-out fracture of the orbit .  Am J Ophthalmol . 1957; 44:733-739.
Fujino T, Makino K.  Entrapment mechanism and ocular injury in orbital blowout fracture .  Plast Reconstr Surg . 1980;65:571-574.Crossref
Anderson RL, Panje WR, Gross CE.  Optic nerve blindness following blunt forehead trauma .  Ophthalmology . 1982;89:445-455.Crossref
Converse JM.  Facial injuries in children . In: Kazanjian VH, Converse JM, eds.  The Surgical Treatment of Facial Injuries . 2nd ed. Baltimore, Md: Williams & Wilkins; 1959:299-315.
Endlow DH.  Facial Growth . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1990: 1-24.
Morin JD, Hill JC, Anderson JE, Grainger RM.  A study of growth in the inter-orbital region .  Am J Ophthalmol . 1963;56:895-901.
Onodi A.  Accessory Sinuses of the Nose in Children . New York, NY: William Wood & Co; 1911:plates 4-90.