Orbital fractures occur less frequently in the pediatric population than in the adult population. Due to the elasticity of the bones that comprise the orbital floor it is not uncommon for the orbital floor to fracture and immediately self-reduce. This puts the muscles and soft tissues of the orbital floor at an increased risk of entrapment. There is no exact agreement in the literature as to the ideal timing of surgical intervention for these types of injuries. However, there are many surgeons who advise early intervention in the first few days of the injury. This article describes a case of a non-displaced orbital fracture with displacement of the inferior rectus into the maxillary sinus that was treated in the first 24 h and resulted in an excellent outcome.
Pediatric facial fractures are less common than in the adult population, accounting for 3–6% of all facial fractures. Orbital floor fractures make up 15% of all pediatric facial fractures, and pediatric cases make up 22% of all orbital fractures requiring surgery.
There are few facial fractures that require urgent surgical intervention. Pediatric orbital fractures can be one of them. These fractures can differ from adult orbital fractures in signs and symptoms, fracture pattern, and urgency. In children, due to the elasticity of the bone, the fractured floor has the tendency to return to the original anatomic position. When this occurs there can be minimal displacement of the floor with entrapment of muscle and soft tissues within the fracture site. Clinically this can result in decreased motility, nausea and vomiting, and diplopia. Most facial trauma surgeons advocate early surgical intervention for these types of injuries to prevent ischemia to the inferior rectus muscle. Few cases exist in the literature specifically referring to the inferior rectus muscle being completely displaced into the maxillary sinus after a trapdoor orbital fracture. This report describes a case of a non-displaced orbital fracture with the inferior rectus displaced into the maxillary sinus that was treated immediately, resulting in an excellent outcome.