Inferior Oblique Palsy: A Transient Complication Related to Inferior Orbital Wall Fracture in Childhood

Jung-Hye Lee

PURPOSE: To evaluate inferior oblique (IO) muscle palsy related to orbital floor fracture and its management

DESIGN : Retrospective, observational case series.

METHODS: We retrospectively assessed 137 patients with orbital floor fractures who had undergone surgical repair by one surgeon between July 2003 and August 2009. Review of clinical data, which included photographs and radiologic findings were performed. IO muscle palsy was diagnosed based on abnormal head position, Parks' three-step test, the Hess test, and the nine diagnostic position of gaze.

RESULTS: Twelve patients demonstrated oblique IO muscle palsy pattern (8.8%); 3 patients presented pre-operatively and 9 patients presented post-operatively. The median age was 9.5 years (range, 6~24 years) and all of the patients were males. Ten patients (85%) presented with nausea and vomiting symptoms, 2 (17%) infraorbital hypoesthesia, and 3 (25%) pupillary dilatation. Based on the CT scan, all patients had trap door fractures with soft tissue entrapment. The IO muscle palsy recovered spontaneously within 2 months without any treatment.

CONCLUSION: Head tilt toward the injured side can be a warning sign of IO palsy in orbital floor fracture, especially pre- or post-operatively in the pediatric population. Physicians managing pediatric orbital fracture should be aware of this transient complication.