Treating Pulsatile Exophthalmos in Child with Minimally Invasive Approach and Custom-made Titanium Mesh Plate

Orbital roof fractures due to craniofacial trauma are not common. An estimated 1–9% of facial bone fractures involve the orbital roof.1 Physical signs and symptoms may include diplopia, enophthalmos, exophthalmos, hyperglobus, and hypoglobus. Little bony displacement is seen in most cases involving children, and surgical intervention is not required in most cases (53–93%).2,3 However, serious complications such as pulsatile exophthalmos arise once the bone is severely displaced. Such severe displacement is very rare (seen in 5% of orbital roof fractures),4 but early surgical intervention is essential to avoid or address visual disturbance. Here, we present the case of a child who underwent reconstruction of the anterior cranial base in a minimally invasive approach using custom-made titanium mesh.