Orbital Roof Fractures in Children from the Point of View of a Neurosurgeon

Childhood is a highly risky age group in terms of orbital injuries. Injuries of the forehead in the presence of orbital ecchymosis, swelling and haematoma of the eyelids, infiltration and swelling of the surrounding tissues and the face must be carefully examined for a high level of suspicion of the presence of orbital fracture and exclusion of intracranial complications which may accompany orbital fractures (impressive fracture of the skull, epidural haematoma, pneumocephalus, dilaceration of dura mater, contusion or dilaceration of the brain, liquorrhoea, fronto-orbital encephalocele). An examination must be conducted by a traumatologist (surgeon, neurosurgeon), neurologist, and ophthalmologist. In the case of acute injuries, the most efficient radiological examination is CT, i.e. brain, orbit (with coronary projections as a minimum) and 3-D reconstruction of the skeleton. MR is performed when there is a suspicion of liquorrhoea and orbital encephalocele, and in very small children. The most frequent place of orbital trauma is the orbital roof. Orbital fractures without displaced bone fragments and with exclusion of intracranial complications are treated conservatively. Displaced fragments either in the orbit or the intracranial space indicate an operation. The aim of the operation is to remove displaced bone fragments, stop bleeding and evacuate blood clots, and to reconstruct the damaged bone cover. In the orbit, increased attention must be paid to complete liberation of the optic nerve, ophthalmogyric muscles, and other potential compressed structures. Parallel neurosurgical treatment of the intracranial trauma is obvious and, in many cases, of priority. The timing of the operation is within 24 hours after the injury unless the condition requires urgent operation (open injuries, epidural bleeding).