Plast Reconstr Surg. 2025 Oct 23. doi: 10.1097/PRS.0000000000012562. Online ahead of print.
ABSTRACT
BACKGROUND: Pediatric orbital trapdoor and linear fractures may involve entrapment of the extraocular muscles (EOM), potentially causing irreversible ocular motility impairment if surgical intervention is delayed. The optimal timing for surgery in cases with EOM strangulation remains uncertain.
METHODS: We retrospectively reviewed 103 pediatric cases from our medical records of 389 patients with orbital fracture. A systematic review was conducted following PRISMA 2020 guidelines. Data from 10 previous studies and our institutional cohort were combined, including 101 patients under 20 years old with radiologically confirmed EOM entrapment. Patients were stratified by time to surgery: within 24 hours, 24-72 hours, and beyond 72 hours.
RESULTS: Surgical intervention within 24 hours was significantly associated with better postoperative ocular motility outcomes compared to delayed surgery (p < 0.05). In our cohort, cases treated within 8 hours achieved excellent recovery, with Hess Area Ratio (HAR%) exceeding 85% and no residual diplopia. Patients without EOM entrapment improved with an average of 7 weeks of conservative management.
CONCLUSIONS: This study supports urgent surgical repair within 24 hours for pediatric orbital fractures with EOM entrapment to maximize functional outcomes. In cases of soft tissue entrapment without sustained oculocardiac reflex, non-operative management with close follow-up may be appropriate. Prompt diagnosis and timely referral remain critical to avoid permanent sequelae.
PMID:41129826 | DOI:10.1097/PRS.0000000000012562
