Managing Subacute Subperiosteal Hematoma with High Intraocular Pressure: A Case Report

Subperiosteal haematoma of the orbit is an uncommon complication of maxillofacial trauma, hence easily missed. It usually presents subacutely with proptosis and diplopia. In our case, the subperiosteal haematoma is complicated with high intraocular pressure, necessisating measures to reduce the intraocular pressure. Unresponsive to only medical treatment, surgical evacuation was carried out in this patient. Removal of the clot finally relieved the intraocular pressure and simultaneously improved the proptosis and the cumbersome diplopia.

Osteoneogenesis on Subperiosteal Orbital Hematoma in a 10-Year-Old Boy

PURPOSE: We report the first case in Korea of rapid bone formation on a subperiosteal orbital hematoma after trauma. CASE SUMMARY: A 10-year-old boy who was in the intensive care unit after trauma showed proptosis and ocular movement limitation of the right eye associated with subperiosteal hematoma. On ocular examination, 3 mm of proptosis and limitation of right eye movement were observed; however, visual acuity was not decreased. At 1 month after the trauma, orbital computed tomography (CT) showed new bone formation at the margin of the hematoma border although the size of the hematoma decreased. The patient underwent hematoma and bony tissue removal using anterior orbitotomy approach. A new bone was formed between the orbital border and hematoma from the anterior orbital margin to the orbital apex. During pathological examination, woven bone tissue with fibrotic tissue was observed in the hematoma wall. One year after surgery, the patient's proptosis and limitation of ocular movement disappeared without any evidence of new bone formation. CONCLUSIONS: Waiting for spontaneous absorption of orbital subperiosteal hematoma is usually recommended unless there is significant functional impairment. However, as in our case, new bone formation could occur during a short period of less than 1 month; imaging follow-up is necessary in patients having intensive care or showing delayed absorption of a hematoma.

Clinical features and management of posttraumatic subperiosteal hematoma of the orbit.

Traumatic subperiosteal hematoma (SpH) usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

Céfalo-hematoma subperiosteal gigante ossificado na infância / Ossified giant subperiosteal cephalhematoma in childhood

Hematoma subperiosteal ou céfalo-hematoma, apesar de condição conhecida em neonatos, é rara em adultos e mesmo em crianças maiores, o que levanta a suspeita de uma diferente patogênese entre as duas situações. A cronificação e a ossificação do céfalo-hematoma são condições extremamente infrequentes, com escasso material bibliográfico, e sua presença no adulto é fato inusitado na literatura. Reportamos o caso de um hematoma subperiosteal crônico de grandes proporções, ossificado, com um ano de evolução, tratado cirurgicamente, em um menino de 12 anos de idade com síndrome epiléptica e déficit cognitivo prévios. A revisão e a discussão de sua patogênese e seu tratamento foram realizadas para exposição da condição.

Subperiosteal hematoma or cephalhematoma is a well known condition on newborns, but rare in adults and older children, what may lead to a different pathogenic origin. Chronic or ossificated cephalhematoma are infrequent, with few reports in medical literature. There are no cases reported in adults. It is presented a case of a 12 year-old boy, with previous epileptic syndrome and cognitive deficit, who was admitted because of a large chronic ossified subperiosteal hematoma. It was removed surgically. Revision and discussion of its pathogenesis were prepared for the case presentation.

Spontageous orbital subperiosteal hematoma

Subperiosteal hematoma of the orbit is uncommon and mostly produced by trauma or diseases such as leukemia, hemophilia and scurvy. A spontaneous occurrence which is not associated with any of these causes, however, is extremely rare. We report a case of a 27-year-old woman. The presenting symptoms were proptosis, lid edema and diplpia which developed suddenly. Clinical features, orbital echography, computerized tomography and magnetic resonance imaging established the diagnosis of spontaneous subperiosteal hematoma of the orbit. It was managed successfully by conservative treatment. A patient profile, mode of clinical presentation, imaging findings, pathogenesis and management options are discussed.

Exophthalmos Caused by Subperiosteal Orbital Hematoma

Frequent causes of exophthalmos are orbital inflammations, vascular disorders, various orbital neoplasms, metabolic diseases, and developmental anomalies. But subperiosteal hematoma is a rare cause of exophthalmos. We experienced three cases of exophthalmos caused by the subperiosteal hematoma and managed successfully by needle aspiration and conservative treatment.