Role Of Cbct In The Treatment Of Orbital Floor Blow Out Fractures In Children

Abstract

Background, Aim, and Objectives: Orbital floor blow out fractures are uncommon in children but can present with a dilemma in the Emergency department upon presentation. We collected case reports of 17 cases over a three-year period. The patients were selected from the age group six to 13 years of age with history of trivial blunt orbital trauma. The main complaint was mild pain in the eye upon presentation. Five patients were having clinical presentation of oculo-cardiac reflex. The suspected patients underwent Cone Beam CT of the midface with multiplanar cone beam reconstruction which confirmed the diagnosis of orbital floor fractures with trap door defect or minimal displacement and in a few cases inferior rectus entrapment. Orbital floor trapdoor fractures have oblivious features upon presentation and can easily be overlooked if not evaluated managed by expert healthcare providers which can lead to significant morbidity and even mortality in patients with oculocardiac reflex. Cone Beam CT of mid face with multiplanar reconstruction is the standard of care in the diagnosis and management of white eyed blow out orbital floor fractures in the provision of evidenced based healthcare practice. Methodology: This is a retrospective cohort study to evaluate the results of pediatric age group with trapdoor and blow out orbital floor fractures who underwent CBCT for the diagnosis and further management. Seventeen cases were selected who were in the age group between 6 to 13 years.12 cases underwent surgery for orbital floor exploration and nine were having inferior rectus muscle entrapment which was released. Five patients were managed non surgically. Result: One patient disappeared in this group during one-year post-operative follow up. No residual defect was found in the remaining sixteen patients. Cone beam Computer tomography with multiplanar reconstruction should be the standard of care for the diagnosis and treatment of blow out and trapdoor orbital fractures. Strength and limitations: Although this study is of a limited number of pediatric patients, but it highlights the significance of CBCT in the management of trapdoor and blow out orbital floor fractures in children. Further studies are needed to elaborate the utilization of CBCT in the treatment of orbital floor and medial orbital wall fractures. Conclusion: Our study suggests that CBCT has a higher value of specificity and less radiation exposure in the diagnosis of orbital fractures in pediatric age group when there is isolated orbital or mid face trauma, and CT brain is not recommended. Cone Beam CT with multiplanar reconstruction is considered the standard of care in the diagnosis of white eyed blow out orbital floor fractures in the provision of evidenced based healthcare practice. Perioperative CBCT and navigation should be universalized to achieve the best outcome.