Objective:
Orbital trapdoor fracture is more frequently seen in pediatric patient with facial trauma. Early intervention and strategies of management based on entrapment content are advocated by previous studies. However, there’s still no consensus on the appropriate timing and indication of operative intervention due to low incidence of trapdoor fracture and insufficient cases reported. In our retrospective study, we compared the outcome between patient groups with different time interval to surgical intervention and with different content of entrapment (muscle versus soft tissue).
Material and Methods:
Twenty-three patients (under 18 years old) who underwent surgery at Chang Gung Memorial Hospital for trapdoor fractures between January 2001 and September 2018 were enrolled. Their demographics, clinical features, surgical timing and follow-up information were collected.
Results:
The mean age was 10.8 ± 3.6 years old. The male to female ratio was 17:6. There were 12 muscle and 11 soft tissue entrapments. The time interval from injury to operation was 12.95 ± 16.8 days with 6.0 ± 8.8 and 20.5 ± 20 days in muscle and soft tissue trapdoor fracture respectively. There was no significant differences in diplopia and extraocular movement (EOM) recovery rate in patients who underwent surgery within 3 days and those over 3 days. However, in patients with interval to surgery over 3 days, patients with rectus muscle entrapment required longer time to recover from EOM restriction (P=0.03) and diplopia (P=0.03) than those with soft tissue entrapment. Regardless of time interval to surgery, patients with muscle entrapment tended to have more obvious preoperative EOM restriction (P=0.002), take longer time to recover from EOM restriction (P=0.036) and diplopia (P=0.042), and have worse EOM recovery rate (P=0.026) compared to patients with soft tissue entrapment.
Conclusions:
Trapdoor fracture with rectus muscle entrapment still results in poorer functional recovery in EOM restriction and taking longer time to recover from EOM restriction and diplopia than soft tissue entrapment. Though early intervention (< 3 days) led to no significant reduction in the recovery rate of EOM restriction and diplopia, cases with rectus muscle entrapment significantly require longer time to recover from EOM restriction and diplopia compared to soft tissue entrapment at intervention more than 3 days. Hence, we suggested that trapdoor fractures with rectus muscle entrapment should be promptly managed at early stage for better outcome and faster recovery.