• Masaaki Kosaka, Tadayoshi Sakamoto, Kohsaku Yamamichi, and Yuri Yamashiro.
• From the Department of Plastic Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan.
• J Craniofac Surg. 2014 Jan 1; 25 (1): 247-52.

PurposeWe report the 2 pediatric patients who had radiographic confirmation of a rare case of medial orbital wall "trapdoor" fracture with extraordinary symptoms of oculocardiac reflex (OCR).MethodsThis was a small interventional case series.ResultsThis is the retrospective report of 2 boys (13 and 10 years old) who developed diplopia, pain, nausea/vomiting, and general malaise following blunt trauma. However, the onset pattern of OCR was absolutely different: delayed onset of OCR just following therapeutic forced duction test to treat the orbital content herniation in the first case and a sudden onset after injury in the second case. In both cases, urgent surgery led to complete normalization of ocular motility.ConclusionsPrompt diagnosis and proper treatment are critical to maximize clinical outcome for this rare and critical trauma.

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