1

2

3

4

5

6

I Made Suka Adnyana

Plastic Reconstructive Surgery

Medical Faculty of Udayana University/

Sanglah Hospital

7

Orbit pyramidal, bony cavity in facial skeleton

Base : anterior openi ng

Apex: posterior

8

9

10

Eyeball

Optic nerve

Ocular mucles

Fascia

Nerves

Vessels

Fat

lacrimal gland

Conjuctival sac

11

Orbital rim

Isolated fracture of internal orbit

combination

12

Destruction of floor or medial wall of the orbit

Displacement of orbital contents into the sinus cavity

13

14

15

16

Classification of orbital Blow-out Fractures

1. Pure Blow-Out FracturesFractures through the thin areas of orbital floor, medial and lateral wall. The orbital rim is intact

2. Impure Blow out fracturesFractures associated with fracture on adjacentfacial bones. The thick orbital rim is fractured and its backward displacement causes a communitionof the orbital floor.

17

Converse and Smith ,1957

blow out fracture caused by sudden icrease in intraorbital pressure (Hydraulic Pressure)

18

External pressure striking the globe and orbital rim produces

A fracture of the floor of the orbit with entrapment of orbital

soft tissue 19

•Reny and stricker,1969; Fujino T,1974

Increased hydraulic pressure within the orbit was not essential.

Linier fractures of the orbital floorby striking the orbital rim.

Increased the force a typical fractures of the posterior orbital floor occurred.

Orbital floor fractures can be produced :- Rim impact- Eyeball impact

20

Mechanism of orbital blow-out fracture

21

Diplopia- extraoculer muscle imbalance (vertical)

- Deviation visual axis

- displacement ocular globe exceed 5mm

for diplopia

22

23

Enophthalmos

• Second major complication

• orbital enlargenment with the escape of orbitalsoft tissue into an enlarged orbital cavity

24

25

Enophtalmos

L globe Immobility

26

Loss of bony orbital support and disruption on the ligamentSystem allow displacement of central orbital fat to a morePeripeheral system.

27

DIPLOPIA AND ENOPTHALMUS

1. Diplopia (+), enopthalmus (+).

2. Diplopia (+), enophthalmos (-)

3. Diplopia (-), enopthalmos (+)

4. Diplopia (-), enophthalmos (-)

28

Early examination :

no double vision caused temporarily closed by edema of eyelids.

swelling and hemorrrhage in periorbital tissue.

no appear displaced of ocular globe

29

Examination of rotation upward in normalrange

If the affected eye is not able to rotate upward inNormal range, restriction in rotation in other direc-tion is also observed.

The function of inferior rectus and inferior obliqueMuscle restricted by entrapment of structures orContusion

30

31

32

Double vision

Limitation of forced rotation of eyeball

Radiographic evidence of extensive fracture

Enopthalmus or significant globe positional

change

33

Plain films and CT scan

Blow-out fracture is frequently missed if does not include CT scan

“hanging drop” : orbital fat extruded into

maxillary sinus

34

Tear drop sign

35

36

Disengange entrapped structures and restore oculorotatory functions

Replace orbital contents into the bony orbital cavity

Restore orbital cavity size (volume) and replace the tissues into proper position

37

It is not necessary to operate immediately,

particularly if posttraumatic edema,retinal

detachment or hypema ec. globe injuries

Early surgical intervention, make better

functional results.

38

Exposure orbital floor technique

Subciliar approach

39

40

41

42

43

44

Complication

•Persistent diplopia

•Persistent enophtalmos

•Blind

Suksma

45