orbital blowout fractures (4)

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Orbital blowout fractures Anthony Greer

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Page 1: Orbital Blowout Fractures (4)

Orbital blowout fractures

Anthony Greer

Page 2: Orbital Blowout Fractures (4)

Blow out fractures

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

Page 3: Orbital Blowout Fractures (4)

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 the floor.

Page 4: Orbital Blowout Fractures (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

Page 5: Orbital Blowout Fractures (4)

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

Page 6: Orbital Blowout Fractures (4)

Coronal CT

• CTs are diagnostic method of choice

• Coronals provide best view

• CT can show – extraocular muscle

rounding– Herniation of fat into

maxillary sinus

Page 7: Orbital Blowout Fractures (4)

Images – Coronal CT

• The image reveals herniation of fat into the left maxillary sinus

Page 8: Orbital Blowout Fractures (4)

Coronal CTs

Page 9: Orbital Blowout Fractures (4)

X-ray (waters view)

• Image shows depressed fragment of the left orbital floor (arrow) and an air-fluid level in the left maxillary sinus

Page 10: Orbital Blowout Fractures (4)

Clinical Images

A) orbital floor fracture with hypoophthalmus and ptosis

The left eye fails to elevate in up-gaze (hypotropia).

Page 11: Orbital Blowout Fractures (4)

Management

• Medical management for asymptomatic patients– IV antibiotics and short course of oral steriods

• Surgical management for symptomatic patients (occurs in most cases)

Page 12: Orbital Blowout Fractures (4)

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.