Subacute phase treatment of subperiosteal hematoma of the orbit with epidural hematoma in the frontal cranial fossa: case report

Acute subperiosteal orbital haematoma following general anaesthesia in the setting of recent trauma

Subperiosteal orbital haematoma (SOH) is an uncommon condition that involves bleeding within the potential space between the periosteum and orbital bone. This typically occurs within the superior orbit. If the SOH is large enough it can compress orbital structures and be sight threatening. Therefore, it is important for the clinician to recognize the potential causes for this phenomenon which will help guide the diagnosis. Herein we describe a unique case of unilateral SOH in a 47-year-old male following otherwise uncomplicated general anaesthesia. This occurred 6 weeks after a motorbike accident in which there was no facial/ocular injury. This case report identifies for the first time the potential for a late-onset SOH in the setting of a stressor event. It also highlights the potential for this condition to occur following general anaesthesia in a supine patient having a non-cardiac procedure, previously recognized as a potential stressor.

Pediatric posttraumatic orbital subperiosteal hematoma

AIM

To report five children with posttraumatic orbital subperiosteal hematoma.

METHODS

In this study, five cases with posttraumatic orbital subperiosteal hematoma were studied and reviewed along with similar cases in a systematic literature review.

RESULTS

The mean age of our patients was 9.40 ± 3.51 years, ranging from 4 to 13 years, and all were male. Mechanisms of injuries were blunt trauma, falling from a building, car accident, and falling from a bicycle. All patients had unilateral involvement. Treatment options included needle aspiration, surgical drainage, and observation for spontaneous resolution. Except for one patient, positive outcomes were achieved.

CONCLUSION

The most common location for posttraumatic orbital subperiosteal hematoma is the superior orbital wall. Traumatic optic neuropathy and permanent visual loss are uncommon. Observation, surgical drainage, and aspiration are common treatment options.

Subperiosteal hematoma in multiple settings

Most reports of orbital hemorrhage do not distinguish among intraconal, extraconal, and subperiosteal hemorrhages, although several reports describe isolated subperiosteal hematomas as a separate entity. We report 3 cases of subperiosteal hematoma with different etiologies but similar progression of signs and symptoms. Each patient presented with spontaneous proptosis, rarely caused by orbital subperiosteal hematoma, measuring approximately 5 mm. Over the course of 4-10 days their conditions worsened and warranted intervention. All 3 cases were treated with anterior orbitotomy, and visual acuity returned to baseline following surgery in all.