Best of five
- A. Routine review in two weeks
- B. Treat nausea and discharge
- C. Force repeated eye movements to release the muscle
- D. Urgent specialist orbital assessment for muscle entrapment
- E. Operate solely according to fracture size
FRCS (ORL-HNS) · SECTION 1 SBA
Paediatric orbital-floor trapdoor fracture
A child has nausea, bradycardia and marked restriction of upward gaze after facial trauma. CT shows a small orbital-floor defect with little external bruising. What is the best next step?
D. Urgent specialist orbital assessment for muscle entrapment
The oculocardiac reflex and restricted movement signal trapdoor entrapment and potential muscle ischaemia. Apparent mild external injury or a small CT defect must not lower urgency.
Why every option is right or wrong
A. Routine review in two weeks: Delay risks persistent diplopia and muscle injury.
B. Treat nausea and discharge: The autonomic signs are a marker of entrapment, not isolated gastroenteritis.
C. Force repeated eye movements to release the muscle: This is painful and does not relieve entrapment.
D. Urgent specialist orbital assessment for muscle entrapment: The oculocardiac reflex and restricted movement signal trapdoor entrapment and potential muscle ischaemia. Apparent mild external injury or a small CT defect must not lower urgency.
E. Operate solely according to fracture size: Clinical entrapment, not defect size alone, determines urgency.
What if the scenario changed?
If ocular movements were full with no diplopia, enophthalmos or oculocardiac symptoms, observation could be reasonable.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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