Complex Orbital Floor Fractures

Orbital fractures are commonly the result of blunt or periocular trauma. Management of these fractures can often be complex and challenging involving many specialties including emergency room (ER) physicians, radiologists, ophthalmologists/optometrists, and oculoplastic surgeons. Best patient outcomes are often associated with accurate radiological diagnostic findings, close patient monitoring, and in some cases surgical intervention. This case report describes an 11-year-old African American male child who hit the side of his face on a table while playing. The patient proceeded to the emergency room and was given a CT scan of the maxillofacial bones. No fractures were reported, and the child was sent home. That same evening the child was transported back to the ER because he passed out in the middle of the night. The CT findings were re-evaluated to find a trapdoor fracture of the left inferior orbital floor with left inferior rectus entrapment and exacerbation of the oculocardiac reflex (OCR). The patient was referred for surgery and underwent emergent surgical release of entrapped tissue and repair of the orbital fracture with the placement of an orbital implant improving supraduction of the left eye. The patient was then discharged and has made a full recovery.