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Orbital blowout fractures

Orbital blowout fractures. Anthony Greer. Blow out fractures. Term "blow-out fracture" when describing inferior rectus entrapment with decreased ocular motility in the setting of an orbital floor fracture. Orbital Anatomy.

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Orbital blowout fractures

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  1. Orbital blowout fractures Anthony Greer

  2. Blow out fractures • Term "blow-out fracture" when describing inferior rectus entrapment with decreased ocular motility in the setting of an orbital floor fracture.

  3. Orbital Anatomy • The orbital plate of the maxilla joins the orbital plate of the zygoma and the orbital plate of the palatine bones to form thefloor.

  4. Mechanism • The mechanism is controversial. • There are two main theories are a result of : • The sudden increase in intraorbital pressure • "buckling" forces which are transmitted to the orbital bones by transient deformity

  5. Clinical Signs and symptoms • Enophthalmos • recession of the eyeball within the orbit • Diplopia • Double vision • especially on upward gaze • Due to inferior rectus entrapment • Hypesthesia  • Reduced sense of touch or sensation • Due to injury of infraorbital nerve • Usually have numbness of the gingiva and of the skin of the midface

  6. Coronal CT • CTs are diagnostic method of choice • Coronals provide best view • CT can show • extraocular muscle rounding • Herniation of fat into maxillary sinus

  7. Images – Coronal CT • The image reveals herniation of fat into the left maxillary sinus

  8. Coronal CTs

  9. X-ray (waters view) • Image shows depressed fragment of the left orbital floor (arrow) and an air-fluid level in the left maxillary sinus

  10. Clinical Images The left eye fails to elevate in up-gaze (hypotropia). A) orbital floor fracture with hypoophthalmus and ptosis

  11. Management • Medical management for asymptomatic patients • IV antibiotics and short course of oral steriods • Surgical management for symptomatic patients (occurs in most cases)

  12. References • Cruz, AA, Eichenberger, GC. Epidemiology and management of orbital fractures. Curr Opin Ophthalmol 2004; 15:416. • Jatla, KK, Enzenauer, RW. Orbital fractures: a review of current literature. Curr Surg 2004; 61:25. • Long, J, Tann, T. Orbital trauma. Ophthalmol Clin North Am 2002; 15:249. • Burnstine, MA. Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol 2003; 14:236.

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