Oculocardiac reflex in a pediatric orbital floor fracture: A case report
Abhay Taranath KAMATH, Srikanth GADICHERLA, Neha SHARMA, Anand Deep SHUKLA, Satpal Singh GILL
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciencies, Manipal University, Karnataka, India (Head: Professor Abhay Taranath Kamath)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 59-64
SUMMARY: Maxillofacial surgeons seldom encounter facial fractures that warrant urgent treatment. Such an indication is related to orbital floor fracture when it induces the oculocardiac reflex (OCR), a condition which clinically manifests as headache, nausea, vomiting, bradycardia and potential syncope. In the reported case, the management of bradycardia in a 5-year-old pediatric patient with an orbital blow out fracture, after a hit by a ball on the right side of his face 24 hours before, is described. Bradycardia was attributed to inferior rectus muscle entrapment, as there was no other known etiology. The patient was taken to the operating room for right orbital floor exploration and repair without any further delay. A trapdoor fracture of the right orbital floor was evident, which was treated by release of the herniated orbital contents and the entrapped inferior rectus into the correspondent maxillary sinus, followed by reconstruction of the orbital floor with AO Synthes pediatric orbital titanium mesh. On the third postoperative day there was complete resolution of the patient’s ocular disturbances, as well as of nausea, vomiting and the persistent hemodynamic instability associated with oculocardiac reflex.
KEY WORDS: orbital floor fracture, blow-out fracture, children, muscle entrapment, bradycardia
REFERENCES
Cohen SM, Garret CG: Pediatric orbital floor fractures: Nausea/ vomiting as signs of entrapment. Otolaryngol Head Neck Surg 129:43- 47, 2003
De Man K, Wijngaarde R, Hes J, et al.: Influence of age on the management of blow-out fractures of the orbital floor. Int J Oral Maxillofac Surg 20:330–336, 1991
Dersu I, Wiggins MN, Luther A, Harper R, Chacko J.: Understanding Visual Fields Part I: Goldmann Visual Fields. J Opthalmic Med Tech 2:1, 2006.
Gerber B, Kiwanuka P, Dhariwal D.: Orbital fractures in children: A review of outcomes. Br J Oral Maxillofac Surg. 51:789-93, 2013
Gerbino G, Roccia F, Bianchi F.A, Zavattero E.: Surgical Management of Orbital Trapdoor Fracture in a Pediatric Population. J Oral Maxillofac Surg 68:1310-1316, 2010
Grant JH, Patrinely JR, Weiss AH, et al.: Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg. 109:482-489, 2002
Kim BB, Qaqish C, Frangos J, John F, Caccamese JF.: Oculocardiac Reflex Induced by an Orbital Floor Fracture: Report of a Case and Review of the Literature. J Oral Maxillofac Surg 70:2614-2619, 2012
Lübbers HT, Zweifel D, Grätz KW, et al.: Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 68:1317-1321, 2010
Sires BS, Stanley RB, Jr, Levine LM: Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol. 116:955–956, 1998
Thelogie-Lygidakis.N, Iatrou I, Alexandridis C.: Blow out fractures in children: six years experience. Oral Surg Oral Med Oral Pathl Oral Radiol Endod 103:757-63, 2007
Worthington JP.: Isolated posterior orbital fractures, diplopia and oculocardiac reflexes: a 10- year review. Br J Oral Maxillofac Surg. 48:127-130, 2010
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciencies, Manipal University, Karnataka, India (Head: Professor Abhay Taranath Kamath)
Hellenic Archives of Oral & Maxillofacial Surgery (2014) 2, 59-64
SUMMARY: Maxillofacial surgeons seldom encounter facial fractures that warrant urgent treatment. Such an indication is related to orbital floor fracture when it induces the oculocardiac reflex (OCR), a condition which clinically manifests as headache, nausea, vomiting, bradycardia and potential syncope. In the reported case, the management of bradycardia in a 5-year-old pediatric patient with an orbital blow out fracture, after a hit by a ball on the right side of his face 24 hours before, is described. Bradycardia was attributed to inferior rectus muscle entrapment, as there was no other known etiology. The patient was taken to the operating room for right orbital floor exploration and repair without any further delay. A trapdoor fracture of the right orbital floor was evident, which was treated by release of the herniated orbital contents and the entrapped inferior rectus into the correspondent maxillary sinus, followed by reconstruction of the orbital floor with AO Synthes pediatric orbital titanium mesh. On the third postoperative day there was complete resolution of the patient’s ocular disturbances, as well as of nausea, vomiting and the persistent hemodynamic instability associated with oculocardiac reflex.
KEY WORDS: orbital floor fracture, blow-out fracture, children, muscle entrapment, bradycardia
REFERENCES
Cohen SM, Garret CG: Pediatric orbital floor fractures: Nausea/ vomiting as signs of entrapment. Otolaryngol Head Neck Surg 129:43- 47, 2003
De Man K, Wijngaarde R, Hes J, et al.: Influence of age on the management of blow-out fractures of the orbital floor. Int J Oral Maxillofac Surg 20:330–336, 1991
Dersu I, Wiggins MN, Luther A, Harper R, Chacko J.: Understanding Visual Fields Part I: Goldmann Visual Fields. J Opthalmic Med Tech 2:1, 2006.
Gerber B, Kiwanuka P, Dhariwal D.: Orbital fractures in children: A review of outcomes. Br J Oral Maxillofac Surg. 51:789-93, 2013
Gerbino G, Roccia F, Bianchi F.A, Zavattero E.: Surgical Management of Orbital Trapdoor Fracture in a Pediatric Population. J Oral Maxillofac Surg 68:1310-1316, 2010
Grant JH, Patrinely JR, Weiss AH, et al.: Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg. 109:482-489, 2002
Kim BB, Qaqish C, Frangos J, John F, Caccamese JF.: Oculocardiac Reflex Induced by an Orbital Floor Fracture: Report of a Case and Review of the Literature. J Oral Maxillofac Surg 70:2614-2619, 2012
Lübbers HT, Zweifel D, Grätz KW, et al.: Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 68:1317-1321, 2010
Sires BS, Stanley RB, Jr, Levine LM: Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol. 116:955–956, 1998
Thelogie-Lygidakis.N, Iatrou I, Alexandridis C.: Blow out fractures in children: six years experience. Oral Surg Oral Med Oral Pathl Oral Radiol Endod 103:757-63, 2007
Worthington JP.: Isolated posterior orbital fractures, diplopia and oculocardiac reflexes: a 10- year review. Br J Oral Maxillofac Surg. 48:127-130, 2010
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