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Traumatic Orbital Roof Fractures: Interdisciplinary Evaluation and Management

Cossman, Jack P. B.A.; Morrison, Clinton S. M.D.; Taylor, Helena O. M.D., Ph.D.; Salter, Amanda B. M.D.; Klinge, Petra M. M.D., Ph.D.; Sullivan, Stephen R. M.D., M.P.H.

Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000438051.36881.e0
Pediatric/Craniofacial: Original Articles
Abstract

Background: The orbital roof forms part of the anterior skull base and is positioned for potential concomitant ophthalmologic and neurologic injury. Despite potential morbidity and mortality, orbital roof fractures have garnered little attention compared with orbital floor fractures. The authors’ purpose is to review and describe key points when treating these fractures.

Methods: The authors reviewed 1171 consecutive patient at a trauma center with orbital or skull base fractures from 2009 to 2011. Patient demographics, mechanism of injury, associated injuries, treatment, outcomes, and complications were recorded.

Results: Among the 1171 patients, the authors identified 60 with an orbital roof fracture (5 percent). All were evaluated by plastic surgery, neurosurgery, and ophthalmology. Average age was 38.1 years, and the male-to-female ratio was 4:1. Frequent mechanisms of injury were fall (33 percent), followed by assault (25 percent). Concomitant craniofacial skeletal fractures were common (87 percent), as were ophthalmologic injuries (47 percent), and traumatic brain injury with intracranial hemorrhage (65 percent). Six patients (10 percent) required operative repair of the orbital roof, all of whom had a dural laceration and cerebrospinal fluid leak. Most patients (90 percent) had minimal displacement and no clinically evident cerebrospinal fluid leak and were treated with observation without complications.

Conclusions: Orbital roof fractures are a less common but potentially serious craniofacial injury. Most can be safely observed; however, intracranial or intraorbital injury may warrant surgical intervention to remove impinging bony fragments, repair dura, or reconstruct the orbital roof. An interdisciplinary approach with plastic surgery, ophthalmology, and neurosurgery is crucial to providing comprehensive care.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Author Information

Providence, R.I.

From the Division of Plastic Surgery and the Departments of Plastic Surgery, Pediatrics, Ophthalmology, and Neurosurgery, The Warren Alpert Medical School of Brown University, and Rhode Island Hospital and Hasbro Children’s Hospital.

Received for publication May 21, 2013; accepted October 3, 2013.

Presented at the 19th Annual Brown University and Rhode Island Hospital Research Celebration, October 27, 2011, Providence, Rhode Island; and the 54th Annual Meeting of the New England Society of Plastic and Reconstructive Surgeons, in Newport, Rhode Island, May 31 through June 2, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Stephen R. Sullivan, M.D., M.P.H., Division of Plastic and Reconstructive Surgery, Department of Pediatrics, Warren Alpert Medical School of Brown University, Department of Plastic and Reconstructive Surgery, Rhode Island Hospital and Hasbro Children’s Hospital, 2 Dudley Street, MOC 180, Providence, R.I. 02905, stephen.sullivan@brown.edu

©2014American Society of Plastic Surgeons