The differences of blowout fracture of the inferior orbital wall between children and adults

Objectives: To review the clinical features and recovery period of patients with blowout fractures of the inferior orbital wall treated surgically and to examine the differences between children and adults. Design: A retrospective study. Setting: Department of Otorhinolaryngology, Mary-knoll General Hospital, Busan, Korea. Patients: Medical records of 70 patients were reviewed: 16 patients were children (aged < 16 years) and 54 were adults (aged >= 17 years). Main Outcome Measures: Symptoms and fracture patterns were compared between both groups in all subjects, and the recovery period relative to the timing of surgery after the trauma was compared in subjects who complained of diplopia or extraocular limitation. Results: Serious periorbital edema was noted in 43 adults (80%) and 4 children (25%), diplopia in 27 adults (50%) and 16 children (100%), and extraocular muscle limitation in 23 adults (43%) and 13 children (81%). Trapdoor fractures were frequent in the children group (n=13; 81%), whereas 30 patients (56%) had open-door fractures in the adult group. In the children group, no differences in the recovery period relative to the timing of surgery was noted when all types of orbital fractures were considered. However, among the 13 children with trapdoor fractures, the recovery period was significantly shorter in those who under-went surgery I to 5 days after the trauma compared with those who underwent surgery after 6 to 14 days and 15 days or longer. In adults, the recovery period of those who underwent surgery 1 to 5 days and 6 to 14 days after the trauma were significantly shorter compared with those who underwent surgery after 15 days or longer. Conclusions: Diplopia, extraocular muscle limitation, and trapdoor fractures were more frequent in children than in adult patients. After trauma, surgical intervention might be required within 5 days in children with trapdoor fracture vs within 2 weeks in adults.