Post-traumatic subgaleal hematoma with subperiosteal orbital extension

doi:10.1016/0039-6257(86)90122-0

Survey of Ophthalmology

Volume 30, Issue 4, January–February 1986, Pages 258-262

https://doi.org/10.1016/0039-6257(86)90122-0 Get rights and content

Abstract

Delayed, progressive proptosis is rare following mild head trauma. We describe a case of subperiosteal orbital extension of a subgaleal hematoma and review ten cases from the literature of solitary subperiosteal hematoma and one of subgaleal hematoma with orbital extension. A patient profile, mode of clinical presentation, management options, and an algorithm for management are presented.

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Cited by (44)

Clinico-radiological features and treatment outcomes in children with traumatic orbital subperiosteal hematoma
2018, Journal of AAPOS
Citation Excerpt :
This fact is consistent with our results: all OSpH were located in the superior quadrant of orbit. The bony orbital rim, suture lines, orbital fissures, lateral orbital tubercle, anterior lacrimal crest, trochlear fossa, and perforating vascular foramina mark the sites of firm periosteal adhesions.2,6,7 Hence, these points of firm adhesions limit and define the boundaries of a subperiosteal hematoma.
To study the clinical findings, imaging features, and treatment outcomes in children diagnosed with traumatic orbital subperiosteal hematoma (OSpH).
The medical records of eligible OSpH children treated either via needle aspiration or open surgical drainage were reviewed retrospectively. Three anatomical factors (inferior globe displacement, superior orbital sulcus fullness, extraocular movements) and two functional parameters (visual acuity, pupillary reactions) were used to determine overall success.
A total of 10 children (mean age, 6.8 years; 8 males) were included. All had a history of blunt trauma, unilateral presentation, inferior globe displacement, fullness of superior orbital sulcus, and raised retrobulbar resistance. Diminution of vision and restricted elevation was noted in 7 children, and 4 had a relative afferent pupillary defect. Computed tomography (CT) revealed superior OSpH in all 10 children and, additionally, orbital wall fracture in 4. Needle aspiration of the OSpH was performed in 8 children; 2 underwent open surgical drainage. At a mean follow-up of 8.5 months, all children showed satisfactory improvement in both anatomical and functional parameters:1 child had a persistent nebulomacular corneal opacity, and 1 had minimal upper eyelid edema.
A high index of suspicion, appropriate radiology (CT of orbits), and early management through needle aspiration of OSpH may help in early and satisfactory anatomical and functional outcomes.
Intraocular Pressure Change in Orbital Disease
2009, Survey of Ophthalmology
Citation Excerpt :
Subgaleal hematoma may extend to the orbit and cause IOP elevation (Fig. 4). Intraocular pressure drops after draining the blood through superotemporal subperiosteal approach.215 Secondary rise in IOP encountered in idiopathic orbital inflammation is explained on the basis of increased episcleral venous pressure.
Intraocular pressure change has been found concurrent with many orbital pathologies, particularly those involving proptosis. The objective of this review is to offer an inclusive classification of orbital disease–related intraocular pressure change, not only for oculoplastics and glaucoma specialists, but also for general ophthalmologists. Various orbital conditions associated with increased intraocular pressure and glaucoma are comprehensively summarized, and pathophysiology, clinical manifestations, and treatment options of these diseases are discussed. Graves disease, arterio-venous shunts, trauma, and orbital neoplasia, and other common conditions are discussed in detail; less frequent syndromes such as orbitocraniofacial deformities, phakomatoses, and mucopolysaccharidoses are included for the sake of comprehensiveness, but discussed less extensively.
Cranial traumatism in a child
2009, Feuillets de Radiologie
Ocular involvement after subgaleal hematoma
2008, Journal of AAPOS
Traumatic Subperiosteal Hematoma of the Orbit: A Report of 2 Cases
2008, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Subperiosteal hematomas of the orbit occur most often in children either immediately or within days following orbital trauma.7 The hematoma develops secondary to rupture of subperiosteal blood vessels8 or extension of a subgaleal hematoma.9 The characteristic findings include proptosis, downward displacement of the globe, absence of lid ecchymosis, chemosis without subconjuctival hemorrhage, motility impairment, and varying degrees of visual impairment.
Subgaleal hematoma in child abuse
2006, Forensic Science International
The mother brought her $3 \frac{1}{2}$ -year-old son to a paediatric clinic as his forehead was swollen and bluish in appearance. She was unable to give any explanation for this lesion. Clinically it was noted that a very visible and also palpable, doughy swelling was present both in the forehead as well as the hard skull areas. Some hours later, a massive bilateral periocular haematoma appeared. Whilst X-rays were unable to provide any diagnostic help, the sonographic examination of the skull carried out on the same day revealed an extensive subgaleal haematoma. This phenomenon is described in radiological literature as “scalping” and is caused by the use of considerable, blunt violence against the head (shear stresses, e.g. by pulling at the hair). The mother's boyfriend later confessed forceful pulling of the hair.

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Post-traumatic subgaleal hematoma with subperiosteal orbital extension

Abstract

Surg Neurol

Massive subgaleal hematoma complicating head injury in an adult

Ghana Med J

Subgaleal hematoma in head injuries

Int Surg

Les tumeurs sanguines de la cavite orbitare

Ann Ocul

Spontaneous subperiosteal orbital hematoma

Ann Ophthalmol

Subperiosteal bloodcyst of the orbit: report of a case

Ophthalmol Rec

Subperiosteal hematoma of the orbit

Indian J Ophthalmol