Purpose

Persistent motility restriction after pediatric trapdoor fracture repair remains a clinical challenge. We previously hypothesized that radiologically occult fibrotic adhesions might be a significant cause. This study aims to describe the preliminary outcomes and feasibility of targeted microscopic adhesiolysis in a small series of three pediatric cases referred for persistent diplopia.

---

Methods

We retrospectively reviewed three patients (aged 11–17 years) with persistent motility restriction following initial trapdoor fracture repair. All patients were referred from external institutions following unsatisfactory recovery after primary repair. The procedure involved meticulous excision of fibrotic tissues around the inferior rectus muscle under microscopic guidance. Motility was quantified using the Hess Area Ratio (HAR%).

---

Results

Adhesiolysis occurred 45 days to 6 months post-repair. In Case 1 (a 12-year-old female), HAR% improved from 78.3% to 100% at 6 months, enabling a return to competitive sports. In Case 2 (an 11-year-old male), HAR% rose from 88.3% to 93.3% at 3 months, resolving diplopia in daily activities. In Case 3 (a 17-year-old male), despite severe restriction (HAR% 44.3%) and muscle damage, two sessions improved HAR% to 56.3% at 3 months, eliminating primary-position diplopia. All patients showed subjective improvement without surgical complications.

---

Conclusion

Our preliminary results suggest that microscopic adhesiolysis may offer a viable surgical option for managing persistent motility restriction after pediatric trapdoor fracture repair. While the degree of recovery appears to be influenced by the severity of the initial muscle injury, this approach may facilitate the restoration of functional motility in selected cases.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Tomoyuki	Kashima	Oculofacial Clinic Group

↑ Back to top