Blowout fracture9/16/2023 ![]() Regardless of the necessity for surgical intervention, careful monitoring of these cases for resolution is advisable. Surgical intervention may be needed in some instances. Computed tomography imaging must be obtained in all instances of questionable orbital fracture. A dilated fundus examination is necessary for assessing concerning posterior complications. Entrance testing such as visual acuity measurement, pupil assessment, and extraocular muscle motility evaluation provide useful information regarding suspected severity of an orbital fracture. The goal of treatment is to maintain or restore the best possible physiologic function and aesthetic appearance to the area of injury. In addition to discussing the details regarding this patient’s case, this report highlights fracture types, pertinent imaging, determination of muscle entrapment, and other underlying complications.Ĭonclusion: Careful evaluation is critical in proper management of potential orbital fracture cases. Floor fractures may occur in combination with zygomatic arch fractures, Le Fort type II or III midface fractures, or fractures of other orbital bones. Neuralgia in the distribution of the infraorbital nerve may worsen after surgery. An emergent head computed tomography scan must be performed to evaluate and determine management.Ĭase Report: This case features a 66-year-old Caucasian male with an orbital blowout fracture following a fall. Successful repair of orbital blowout fractures may be complicated by persistent problems. Surgical intervention may be warranted in certain cases. Concerning complications, such as retinal detachment, need to be ruled out at the time of presentation. Common associations with an orbital fracture would include periorbital ecchymosis, subconjunctival hemorrhage, eyelid edema, and crepitus, among others. Rarely fragments from an orbital floor fracture buckle up into the orbit, an injury referred to as a "blow-in" fracture.Background: Head trauma can lead to multiple ocular complications, among the most concerning is an orbital blowout fracture. Oculocardiac reflex may result from entrapment of muscle. Surgery is rarely needed for medial wall fractures. Orbital emphysema is a benign, self-limited condition, but may be aggravated by nose blowing, sneezing or Valsalva maneuver. The treatment of pure orbital blow-out fractures is often conservative but orbital floor repair may be necessary if there are complications such as inferior rectus muscle compromise. In the supine position, fluid and debris in the maxillary antrum can layer against the orbital floor and obscure soft tissue herniating through the fracture.For those patients in whom direct coronal scans are not possible (for example due to other injuries or if the patent is unable to co-operate), axial CT scans with coronal reconstructions are an alternative method of imaging, particularly with the use of multidetector CT. Direct coronal CT scans (with the patient prone) are best for demonstrating blow-out fractures. A CT scan is indicated if there is diplopia or restriction of eye movements, and to assess the extent of the injury. Mild or transient diplopia can occur simply due to the periorbital oedema or haemorrhage. If the inferior rectus muscle or its sheath herniates through the fracture and becomes trapped, it may be compromised resulting in diplopia on looking down or straight ahead. The fracture fragments are rarely demonstrated on plain films. An air-fluid level may be seen in the maxillary sinus. Other signs of a blow-out fracture are air within the orbit (which has entered from the maxillary or ethmoid sinuses), an indistinct orbital floor on occipitomental views and opacification of the sinuses due to blood within them. This appearance has been likened to an opaque tear drop hanging from the roof of the antrum and may be the only radiographic evidence of a blow-out fracture. On occipitomental (facial) x-rays this is seen as a convex mass projecting into the roof of the right maxillary sinus. Orbital contents may then herniate downwards through the orbital floor fracture into the maxillary sinus. The orbital rim remains intact in pure blow-out fractures. These are the thin plates of bone that form the orbital floor (roof of the maxillary antrum) and the medial wall of the orbit (lateral wall of the ethmoid sinuses). There is an acute increase in intraorbital pressure which is relieved by fracture through the weakest parts of the orbit. A blow-out fracture of the orbit results from a direct compressive force to the eye, e.g. ![]()
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