gms | German Medical Science

Objective: Orbital roof fractures associated with cranial and maxillofacial trauma are rarely encountered. Traumatic intraorbital encephaloceles due to orbital roof fractures developing in the early postraumatic period are even rarer.

Method: A five-year-old girl was admitted to the Emergency Department of Karadeniz Technical University School of Medicine with left periorbital ecchymosis sustained after falling down a flight of stairs. Axial and coronal computed tomography (CT) revealed a left orbital cerebrospinal fluid fistula, frontal cerebral contusion and left orbital roof fracture with 3 mm diastasis (Figure 1a, b). The patient was treated with methylprednisolone and phenytoin in case of brain edema and convulsions. Her periorbital edema progressively increased over the next two days. Visual acuity, eye position and extraocular muscle motility of the left eye could not be evaluated due to excessive amount of periorbital edema. Magnetic resonance imaging (MRI) showed extension of the cerebrospinal fluid fistula into the left orbital cavity with contused herniated brain tissue (Figure 1c, d). Surgical treatment via a frontobasal approach with resection of the herniated contused brain tissue, dural water-tight closure and orbital roof reconstruction was performed. Orbital roof was reconstructed with a titanium mesh. The patient was discharged one week after surgery with no periorbital edema or fluid collection. After the first control visit the patient was lost to follow-up for 8 years and referred to our clinic with ophthalmologic and cosmetic complaints. On physical examination, left orbital exophthalmos and ptosis with downward displacement were seen. (Figure 2a, b). The patient was referred to plastic and reconstructive surgery department for cosmetic reconstructions.

Results: Our patient recovered well from surgery, and there were no functional deformities in early postoperative period. 8 years later her left orbital appearance was disturbed. The development of such orbital deformities on this patient is possibly due to titanium mesh used for orbital roof repair.

Conclusions: Because late ocular complications will occur after years, especially in children we strongly oppose the usage of titanium mesh for orbital roof reconstruction. Data regarding the long-term results of reconstruction materials would be of great value for surgeons to reach to a consensus on an ideal graft for the repair of orbital roof avoiding functional impairment and cosmetic deformities.