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UDC: 616.315-017.254-051.1 02 092
LONG-TERM EFFECTS OF INFERIOR ORBITAL WALL FRACTURES ON THE
DENTOALVEOLAR SYSTEM IN CHILDREN
Bekmuradova Charos Yusufovna
Master's` degree of the Department of Pediatric Maxillofacial Surgery, Tashkent State
Medical University, Uzbekistan.
e-mail: charos.bekmuradova@mail.ru
Yuldashev Abduazim Abduvaliyevich,
Doctor of Medical Sciences, Professor of the Department of Pediatric Maxillofacial Surgery,
Tashkent State Medical University, Uzbekistan
Resume:
Fractures of the inferior wall of the eye socket in children are one of the most
common injuries in pediatric maxillofacial surgery. These injuries can have a long-term
impact on the development of the dentoalveolar system. Untimely or inadequate treatment of
such injuries can lead to disruption of normal jaw growth, facial asymmetry, and the
development of various bite disorders, which subsequently require additional orthodontic
intervention and surgical corrections. Studying these consequences is important for
improving the quality of diagnosis and the choice of treatment methods, as well as for
developing preventive recommendations.
Key words:
Isolated fractures of the inferior wall of the orbit in children, trauma to the facial
skeleton, anatomo-physiologic features of the pediatric orbit, maxillary sinus, computed
tomography.
Резюме:
Переломы нижней стенки глазницы у детей - одна из самых
распространенных травм в детской челюстно-лицевой хирургии. Эти травмы могут
оказывать
долгосрочное
влияние
на
развитие
зубочелюстной
системы.
Несвоевременное или неадекватное лечение таких травм может привести к
нарушению нормального роста челюстей, асимметрии лица, развитию различных
нарушений
прикуса,
которые
впоследствии
требуют
дополнительного
ортодонтического вмешательства и хирургической коррекции. Изучение этих
последствий важно для улучшения качества диагностики и выбора методов лечения, а
также для разработки профилактических рекомендаций.
Ключевые слова:
Изолированные переломы нижней стенки орбиты у детей, травма
лицевого скелета, анатомо-физиологические особенности детской орбиты,
верхнечелюстной пазухи, компьютерная томография.
INTRODUCTION:
Most studies have focused on orbital fractures in adult patients, whereas
only a few publications with small numbers of patients have been devoted to assessing the
diagnosis and course of blast fractures of the orbit in children.
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Blast fractures of the orbit include fractures without damage to the orbital ring (edge).
Orbital fractures in children are distinguished by a different mechanism of bone wall
damage, which includes so-called ‘trapdoor’ (‘backdoor’) fractures. Due to the elasticity of
the orbital bones, hatch type fractures are more common in children, which creates
conditions for prolapse of orbital tissues, their impingement on the side of the fracture and
for the occurrence of oculocardial syndrome (Aschner reflex). [1].
Orbital injuries account for 36 to 64% of all blunt trauma to facial bones. In 85% of
identified cases of orbital bone fractures, patients are hospitalised [2-5]. In many countries
the number of orbital injuries according to GBD (The Global Burden of Disease Study) is
increasing [5]. According to Russian data, there was an increase in orbital injuries as a result
of road traffic accidents from 4.9% in 2007 to 12.8% in 2010, and in the general statistics in
recent years domestic injuries prevail, reaching 64.5% of cases [6, 7]. The more frequent
causes of orbital trauma in children are: direct impact (44-61%), road traffic accidents
(15.8%), falls from a height (15%) in polytrauma, and sports injuries (9-11%) [8-10].
Fracture of the inferior wall of the orbit is one of the most common injuries in the structure
of maxillofacial fractures in children. It occurs at any age, more often in adolescents. As a
rule, damage to the eye cavity occurs as a result of domestic, sports, street or unlawful
trauma (blow with a fist or blunt object, fall from a height, road traffic accident, etc.).
Isolated fractures of the inferior wall of the orbit in children occupy a significant place
among the injuries of the facial skeleton, making up to 10-20% of all cases of orbital injuries
in paediatric patients. This problem is especially relevant due to the anatomo-physiological
features of the children's orbit: thinness of bone structures, presence of growing tissues and
high plasticity of the organism. In children, the lower wall of the orbit is most susceptible to
traumatic effects due to its thinness and close proximity to the maxillary sinus [11].
It is practically impossible to determine the presence and localisation of blast
fractures of the inferior wall of the orbit using routine radiographic methods [6].
Computed tomography (CT) is the main method of diagnosing these types of
fractures.
Often, due to the small displacement of orbital bone fragments, radiological
diagnosis of fractures is difficult and uninformative. Multispiral CT with
reconstruction in sagittal and coronal projections and three-dimensional (3D)
reconstruction provides optimal and comprehensive visual information about the
damage to the bony structures of the orbit. Soft tissue imaging as well as
magnetic resonance imaging (MRI) are used to evaluate the intraorbital contents.
To date, there are no clear indications for the use of each technique and there is
no complete picture of the CT characteristics of orbital injury [8, 11, 18]. A
number of specialised CT techniques of the facial skeleton are superior to other
imaging modalities in characterising facial bone damage [8, 12-14]. However,
studies in the USA and South Korea have shown that contrast-free (native) head
CT helps to reliably assess most orbital injuries in children, which in many
cases reduces the need to use thin-section CT of the orbits, which increases
radiation exposure in this category of patients [15-17]. Unfortunately, there are
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no recommendations for imaging of orbits in axial projection to detect and
evaluate facial fractures in children.
Fracture of the inferior orbital wall may be observed as a component of a massive fracture of
the zygomaticomandibular complex (which usually causes crushing of the thin orbital wall)
or as an isolated fracture (the less commonly observed ‘blast’ orbital fracture) caused by a
very sudden increase in intraorbital pressure. ‘Explosive’ fracture usually results from an
impact with an object directed at the eyeball (e.g., a fist or ball) that is slightly larger than
the orbit and penetrates the ocular space only a short distance. The sudden increase in
pressure results in fracture of the ocular bones at the weakest points, usually in the region of
its inferior or medial wall [12,19].
The aim of our study
is to evaluate the long-term effects of inferior oculomandibular wall
fractures in children on the dentoalveolar system, and to identify how untimely or
inadequate treatment may contribute to the development of bite abnormalities, asymmetry
and jaw deformity.
Materials and Methods.
Thirty children (7-14 years old) with isolated fracture of the lower
wall of the eye socket treated at the Tashkent State Dental Institute were included in the
study. The patients were observed for 1.5 years after treatment. Anamnesis was studied in all
patients, comprehensive ophthalmological examination was performed: Visometry with
optimal correction, refractometry, biomicroscopy, ophthalmoscopy, determination of the
character of vision using the four-point colour test according to Wors, tonometry, perimetry,
cephalometry (analysis of SNA, SNB, ANB angles, lower face height), radiography and
MSCT to assess anatomical changes, as well as orthodontic diagnosis using models of dental
rows and functional tests to study bite changes. The position of the eyeball was also
determined using Hertel's mirror exophthalmometer, sensitivity along the innervation of the
inferior oculomotor nerve and oculocardiac syndrome (OCS) were assessed.
Radiological data were obtained (computed tomography, axial thickness at least 1 mm), and
after digital segmentation and mirroring of the healthy orbit to the fracture site (iPlan CMF
3.0.5, Brainlab, Munich, Germany), a patient-specific implant was designed. The decision to
reconstruct the medial wall was made strictly in the coronal projection. The boundary was
marked using markings. In addition, the posterior bulge was analysed in the axial projection
and virtually reconstructed. After data transfer to KLS-Martin (Tuttlingen, Germany) or
Synthes (Umkirch, Germany), fabrication was performed by selective laser melting using
Ti6Al4V Grade IV titanium alloy. The thickness of the PSI was 0.3 mm with a 0.5 mm thick
cord around the circumference. The entire workflow from data acquisition to delivery of the
ready-to-use product took between 6 and 8 working days.
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Figure 1. Operation procedure for computer-assisted, navigated PSI implantation for
orbital reconstruction.
Data were collected and stored using Excel spreadsheets (Excel 13.0, Microsoft
Corporation). Statistical evaluations were performed using SPSS® programme (SPSS
version 25.0, IBM SPSS). Multivariate analysis of variance with repeated measures per
factor was performed to record statistical relationships between groups and time. The
relationship between orbital parameters and therapy regimen was performed using binary
logistic regression, chi-square tests, t-tests, and McNemar's test. Results with p-value less
than 0.05 were considered significan.
Results and Discussion.
The results of the study showed that fractures of the inferior
oculomandibular wall in children can cause long-term changes in the dentoalveolar system,
such as bite disorders (crossbite), facial asymmetry and mandibular deformities. Thirty per
cent of children had bite changes after trauma and 25 per cent had marked facial asymmetry
due to improper repositioning of the inferior ocular wall. Untimely treatment increases the
risk of complications such as bone sclerosis, which hinders normal jaw growth. It is
important to provide timely and adequate treatment using modern diagnostic techniques to
minimise long-term consequences and prevent the need for further orthodontic and surgical
interventions.
Conclusion.
Fractures of the inferior wall of the oculomandibular wall in children can have
a lasting impact on the development of the dentoalveolar system. Untimely or inadequate
treatment of such injuries can lead to bite changes, facial asymmetry and jaw deformities.
Regular follow-up of patients with such injuries, as well as timely intervention using modern
diagnostic and treatment methods, can minimise long-term consequences and prevent the
need for complex orthodontic and surgical interventions in the future.
REFERENCES / ЛИТЕРАТУРА
1.
Baek, S. H. Clinical analysis of internal orbital fractures in children / S.
H. Baek, E. Y. Lee // Korean J. Ophthalmol. – 2003. – V.17. – P. 44–49.
2.
Николаенко В.П., Астахов В.П. Часть 1. Эпидемиология и классификация
орбитальных переломов. Клиника и диагностика переломов нижней стенки орбиты //
Vo
lu
m
e
5,
M
ay
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
Офтальмологические ведомости
. 2009. Т. 2, № 2. С. 56–70 [Nikolaenko V.P., Astahov
V.P. Part 1. Epidemiology and classification of orbital fractures. Clinic and diagnosis of
fractures of the lower wall of the orbit.
Ophthalmological statements
, 2009, Vol. 2, No. 2,
рр. 56–70 (In Russ.)].
3.
Дроздова Е.А., Бухарина Е.С., Сироткина И.А. Эпидемиология, классификация,
клиника и диагностика переломов орбиты при тупой травме (обзор литературы) //
Практическая медицина.
2012. Т. 2, № 4 (59). С. 162–167 [Drozdova E.A, Buharina E.S.,
Sirotkina I.A. Epidemiology, classification, clinical picture and diagnosis of orbital fractures
due to blunt trauma (literature review).
Practical medicine
, 2012, Vol. 2, No. 4 (59), рр.
162–167 (In Russ.)].
4.
Miller A.F., Elman D.M., Aronson P.L., Kimia A.A., Neuman M.I. Epidemiology
and Predictors of Orbital Fractures in Children //
Pediatr. Emerg. Care
. 2018. Vol. 34, No. 1.
P. 21–24. doi: 10.1097/PEC.0000000000001306.
5.
Gomez Rosello E., Quiles Granado A.M., Artajona Garcia M., JuanPere Marti S.,
Laguillo Sala G., Beltran Marmol B., Pedraza Gutierrez S. Facial fractures: classification
and highlights for a useful report //
Insights Imaging
. 2020. Vol. 11, No. 49. doi:
10.1186/s13244-020-00847-w.
6.
Kubal, W. S. Imaging of orbital trauma / W. S. Kubal // RadioGraphics. –
2008. – V 28, № 6. – Р. 1729–1739.
7.
Lalloo R., Lucchesi L.R., Bisignano C., Castle C.D., Dingels Z.V., Fox J.T. et al.
Epidemiology of facial fractures: incidence, prevalence and years lived with disability
estimates from the Global Burden of Disease 2017 study //
Inj. Prev
. 2020. Vol. 26, No. 1.
i27-i35. doi: 10.1136/injuryprev-2019-043297.
8.
Петраевский А.В., Гндоян И.А., Тришкин К.С., Виноградов А.Р. Глазной
травматизм в Российской Федерации //
Вестник офтальмологии
. 2018. Т. 134. № 4. С.
80–83. [Petraevskiĭ A.V., Gndoian I.A., Trishkin K.S., Vinogradov A.R. Ocular traumatism
in Russian Federation.
Russian Annals of Ophthalmology
. 2018. Vol. 134. № 4. P. 80–83.
(In Russ.)]. doi: 10.17116/oftalma201813404180.
9.
Amir R. Ochilov
— Jr. Researcher, Clinical and Research Institute of Emergency
Pediatric Surgery and Traumatology;
10.
Tolibjon A. Akhadov
— Dr. of Sci. (Med.), Professor, Head of the Department of
Radiation Diagnostic Methods, Clinical and Research Institute of Emergency Pediatric
Surgery and Traumatology;
11.
Anna V. Timofeeva
— pediatric surgeon, Clinical and Research Institute of
Emergency Pediatric Surgery and Traumatology;
12.
Ekaterina S. Zajtseva
— radiologist, Department of Radiation Diagnostic Methods,
Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology
13.
Olga V. Bozhko
— Cand. of Sci. (Med.), leading researcher at the Department of
Radiation Diagnostic Methods, Clinical and Research Institute of Emergency Pediatric
Surgery and Traumatology;
14.
Maxim V. Ublinsky
— Cand. of Sci. (Biol.), senior researcher, Clinical and Research
Institute of Emergency Pediatric Surgery and Traumatology;
15.
Dmitriy M. Dmitrenko
— Head of Rg Department Clinical and Research Institute of
Emergency Pediatric Surgery and Traumatology;
16.
Alafaleq, M.; Roul-Yvonnet, F.; Schouman, T.; Goudot, P. A Retrospective Study of
Pure Medial Orbital Wall Fracture Management.
J. Français D’ophtalmol.
2019
,
42
, 592–
596
Vo
lu
m
e
5,
M
ay
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
17.
Kunz, C.; Sigron, G.R.; Jaquiéry, C. Functional Outcome after Non-Surgical
Management of Orbital Fractures-the Bias of Decision-Making According to Size of Defect:
Critical Review of 48 Patients.
Br. J. Oral Maxillofac. Surg.
2013
,
51
, 486–492.
18.
Cornelius, C.-P.; Stiebler, T.; Mayer, P.; Smolka, W.; Kunz, C.; Hammer, B.;
Jaquiéry, C.C.; Buitrago-Téllez, C.; Leiggener, C.S.; Metzger, M.C.; et al. Prediction of
Surface Area Size in Orbital Floor and Medial Orbital Wall Fractures Based on
Topographical Subregions.
J. Cranio-Maxillofac. Surg.
2021
,
49
, 598–612.
19.
Osguthorpe, J.D. Orbital Wall Fractures: Evaluation and Management.
Otolaryngol.
Head Neck Surg.
1991
,
105
, 702–707
