Medial rectus muscle incarceration in pediatric medial orbital wall trapdoor fractures

PURPOSE. We describe two cases of orbital trapdoor fractures with medial rectus muscle incarceration. METHODS. Small interventional case series. RESULTS. This is a retrospective university based report of two healthy males (11 and 14 years old) who developed diplopia following blunt orbital trauma. Both patients had decreased horizontal ocular motility of the involved eye with minimal additional evidence of trauma. Computed tomography (CT) demonstrated no significant bony displacement; however, the left medial rectus muscle was located within the ethmoid sinus in the first and had an abnormal size and shape in the second case. In both cases, during urgent surgical repair, the incarcerated medial rectus muscle was gently released from linear non-displaced medial wall fractures and ocular motility normalized postoperatively. CONCLUSIONS. In pediatric patients sustaining blunt orbital trauma, medial rectus incarceration should be considered and managed accordingly.