Timing, Outcomes And Biomaterials In The Surgical Repair of Paediatric Orbital Fractures: A Systematic Review And Meta-Analysis

Article from Australia

The management of paediatric orbital fractures differs as compared to adults, especially of the entrapped variety, given the anatomical and histological differences in a developing craniofacial skeleton. Despite there being generally accepted management algorithms, there are no quantifiable research data to formally assess these. Therefore, the aim of this systematic review and meta-analysis was to assess the overall surgical management of paediatric orbital fractures, focusing on the optimal intervention time and commonly used biomaterials.

The authors identified 677 patients reported across 25 papers published from 1998 – 2025. The mean age of patients across the studies was 11.9 years. There were interchangeability and non-uniformity in the description of fracture types and the majority of studies combined data for all fracture types. Outcomes used to measure impact of surgery and timing of surgery were ophthalmological signs of diplopia, restriction in ocular motility and enophthalmos.

Image Credits: Basnet A, Chug A, Simre S, et al. (April 09, 2024) Comprehensive Management of Pediatric Orbital Fractures: A Case Series and Review of Literature. Cureus 16(4): e57915. doi:10.7759/cureus.57915 Figure 1: Case one: the coronal section of NCCT face shows pre and post, orbital floor fracture repair by iliac crest bone graft

Key Findings:

1. Surgical intervention overall improved symptoms of diplopia and restriction of ocular motility in paediatric orbital fractures.

2. Early surgical intervention (within the first 72 hours) in the surgical management of paediatric orbital fractures is ideal, irrespective of fracture type.

3. In operated patients where biomaterials were used to repair the orbital fracture, improvement was recorded in primary outcomes measured, irrespective of the type of biomaterial used.

4. Alloplastic materials were used in the majority of patients, with MEDPOR as the most commonly used material when the type of non-resorbable biomaterial was recorded.

5. Some studies used alloplastic material in children as young as 1-year-olds. The long-term impacts remain unknown as none of the studies presented long term data on orbital growth and asymmetry.

Why It Matters:

This systematic review and meta-analysis quantifiably confirms that early surgical intervention (within the first 72 hours) is beneficial in the reduction of the persistence of negative ophthalmological outcomes in the surgical management of paediatric orbital fractures, irrespective of type of fracture. What needs further research, through better recording and standardisation of relevant data, is to assess outcomes between < 24 hour surgical intervention and 24-72 hours surgical intervention, and also comparisons of  inter-fracture type outcomes. Additionally, further assessment of trends and outcomes of modern biomaterial use given their increased usage can also be made.

This research paper was accepted for publication and will be published in the May 2026 edition of the Australasian Journal of Oral & Maxillofacial Surgery (AJOMS). https://www.anzaoms.org/journal/

Authors:

Tang A; Johnston J; McKenzie D; Jeyathevan J; Bordbar P.