THE CRANIOFACIAL INJURY IN THE CHILDREN COMPLICATED BY ORBITAL ENCEPHALOCELE AND PROLAPSE OF THE UPPER FORNIX CONJUNCTIVA
The cranio-orbital injuries are considered to be the most serious consequences of the combined craniofacial trauma. They are characterized by the complicated clinical picture and are responsible for the high rates of disability among the affected patients. It accounts for the necessity of recruiting the highly specialized multi-disciplinary teams of specialists to assure the comprehensive approach to the treatment of the victims. The analysis of the relevant literature publications has demonstrated that the cranio-orbital injuries account for 6% up to 64% cases of craniocerebral damages and 34% of all combined traumas. The children at the age under 7 years more frequently experience fractures of orbital bones than the adult subjects due to the peculiar structural features of the children’s skulls. Encephalocele is an extremely rare complication of the cranio-orbital injuries that can either acquire the acute form or develop gradually within a few years after the injury. Orbital hernia may be associated with the following complications for the organs of vision and their accessory apparatus: exophthalmos, diplopia, rupture of the optic nerve, oedema of the periorbital tissues, retinal detachment, enophthalmos, subconjunctival hemorrhage, complete loss of vision, and the rupture of the eyeball. Prolapse of the upper fornix conjunctiva is an equally rare complication of the injury to the orbital structures. To the best of our knowledge, the available literature publications contain only a single report of such condition. The present article describes the original clinical observations of orbital encephalocele accompanied by the prolapse of the upper fornix conjunctiva in the children who experienced a severe combined craniofacial injury. One patient (a 10 year old boy) suffered from the serious combined trauma resulting from his fall from the fifth floor. Orbital hernia developed within 5 days after the accident. The second case was that of a girl presenting with a severe combined injury inflicted to her during the road traffic accident. She developed the complication in the form of orbital encephalocele on day 13 after the accident. In both cases, the patients suffered from the well apparent paraorbital oedema, exophthalmos with the downward displacement of the eyeball, and the prolapse of the upper fornix conjunctiva.