Reformatted coronal ct of the facial bones demonstrates a fracture of the floor of the left orbit white arrow associated with orbital emphysema blue arrow. Definition orbital floor fractures are common, and result from blunt orbital trauma in which force is delivered to the thin bones of the orbital floor, typically along the infraorbital canal. Each orbit underwent conventional radiographic studies, complex motion tomography, and computed tomographic examinations. Apr 27, 2020 orbital blow out fractures the orbit, or eye socket, is a bony opening that contains the eyeball and the muscles, blood vessels, nerves and fat that help support it. A definitive diagnosis is confirmed by computed tomography scan of the orbit.
When it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. Typically, the floor of the orbit and the medial orbital wall are the bones involved in orbital blow out fractures. Fractures of the orbit merck manuals consumer version. Blowout fracture is characterized by a damage to the orbital walls with intact orbital margins and bone fragments displaced outside the orbit 2, 3. A fracture of the floor and medial walls of the ocular orbit caused by a blunt object, e.
Linear trapdoor or whiteeye blowout fracture of the orbit. Orbital emphysema following nose blowing as a sequel of a. Blowout fractures, or fractures of the orbital wall, are a result of either increased intraorbital pressure from blunt force leading to compression of the orbital tissue and subsequent fracture or blunt force to the orbital rim resulting in buckling of the orbital floor. A blowout fracture is a fracture of one or more of the bones surrounding the eye. Atrue blowout fracture ofthe orbit canoccuras a specific syndromewithoutanyother associated facial fractures the socalled pure blowout fracture or it can be found in association with multiple facial injuries as is frequently the case in automobile accidents. Anatomical correlation was obtained by dissecting the orbits. Full text a case of blowout fracture of the orbital. For fracture of th e orbital floor, the positive signs. An investigation into their anatomical basis volume 81 issue 10 d. Chos office after multiple surgeries to treat injuries suffered in a car crash. Blowout fracture of the orbit, which is a fracture of the orbital wallfloor without orbital rim involvement, is associated with significant morbidity brady et al.
Blowout fractures are caused by direct trauma to the globe which causes an increase in intraorbital pressure and decompression via fracture of the orbital floor. Orbital blowin fractures occur when there is displacement of bone fragments towards the orbits. An example of a patient presenting with a right orbital floor blowout fracture. Orbital blowout fractures occur when there is a fracture of one of the walls of orbit but the orbital rim remains intact. Pathology blow in fracture effectively reduces the volume of the orbit associated intraorbital injuries include extraocular muscle entrapment and. Diplopia plays a major role in blowout fractures of the orbit management dilemma 1. An orbital blowout fracture is a fracture of any wall of the orbit, including the medial wall, lateral wall, posterior wall, the floor, or the roof. Ct scan demonstrates common findings of a blow out fracture with evidence of a depressed right orbital floor bottom. Blow out fracture of the orbit, which is a fracture of the orbital wallfloor without orbital rim involvement, is associated with significant morbidity brady et al. Blow out fracture orbit endoscopic reduction a novel management modality. The fracture of any of the orbital walls can potentially lead to the widening of the cone that the eyeball sits in. Blowout fracture of the orbital floor in early childhood. Most thin portions of the orbit is medial to the infraorbital groove. Isolated orbital fractures are encountered in 4%to16% of all facial fractures, and orbital fractures compose 30%55% of zygomatic complex and nasoorbitalethmoid fractures 1,2.
Anteroposterior views of the orbit usually are obtained with varying angulation of the xray beam vector. One of the earliest descriptions of what is now referred to as blowout fracture of the orbit was reported by lang i889. This can lead to a condition known as enophthalmos where the eye has a sunken appearance. Orbital blowout fractures and race centre for facial. Pathophysiology of blow out fracture of the orbit hydraulic theory pfeiffer in 1943 he said that it is evident that the force of the blow received by the eyeball was transmitted by it to the walls of the orbit with fracture of the delicate portions.
Barotraumatic blowout fracture of the orbit request pdf. The orbit consists of the bones surrounding the eye. Immediate first aid consists of splinting the bone. The timing of orbital floor blowout fracture repair is controversial. The most common injury site is the floor or medial wall figure 1. The importance of examination to detect other features of orbital blow out and entrapment are stressed. Previous reports have shown blow out fracture repair beyond 2 months have worse outcomes in restoring eye motility and diplopia when compared with repair within 2 weeks from time of injury. An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall, typically resulting from impact of a blunt object larger than the orbital aperture, or eye socket. Although the causative trauma is usually substantial, presentation and diagnosis may be delayed in the setting of. Therefore direct injury to the globe forcing it into the orbit was necessary. Orbital blowout fracturereport of two cases springerlink.
Recognition and management of an orbital blowout fracture in an amateur boxer page a. Karsteter, maj, mpt1 craig yunker, ms, atc2 study design. Orbital blowout fractures are usually the result of a direct blow to the orbit, which causes a sudden increase in intraorbital pressure. Wearing goggles may prevent this type of sports related injury. Pdf orbital blowout fractures in sport researchgate. Recognition and management of an orbital blowout fracture. Jun 11, 2010 these socalled whiteeyed blow out fractures should be treated immediately to prevent the musculature from ischemic damage and necrosis. They produced an impact on the orbital soft tissues of a cadaver, increasing. Learningradiology blowout, blow, out, fracture, orbit. The timing of orbital floor blow out fracture repair is controversial. The patient had a zygomaticomaxillary complex zmc fracture with involvement of the orbital floor, which had been repaired by the referring service not an. Internal orbital fractures of this type tend to be overlooked because of the severity of other injuries, or because they are masked by the associated swelling of.
Blowout fractures sometimes cause double vision, a sunken eyeball particularly once the swelling resolves, an eyeball that is lower in the face, a decreased sensitivity to touch and pain around the cheek and upper lip caused by injury to the nerves below the orbit, or an accumulation of air andor blood in the tissues under the skin subcutaneous emphysema and. The possibility of damage to the globe is often overlooked once the fracture is recognized. Surgical exploration was carried out six days after the initial injury and direct visualization of the orbital floor was obtained. Observation might have led to a different outcome for a young man who ended up in dr. When the blow out fracture occurs as a result of a direct injury, it is usually in conjunction with a nasoorbital fracture, which results from direct application of. Orbital blow out fractures were experimentally created in eight human cadavers. Roentgen diagnosis of blowout fracture of the orbit. Introduction the fractured orbital floor is a common injury in adults, and is frequently caused by interpersonal violence.
Orbital fractures symptoms, diagnosis and treatment. A case of orbital emphysema as a sequel of a snowboard related head injury is reported. Fractures of the orbit are common yet challenging to manage. The purpose of surgery is to restore the orbit to its original status before injury. It is believed that a fracture of the medial orbital wall was caused by the increased intraorbital pressure when the patient hit his forehead on the snowy ground, allowing air to enter the orbit when he blew his nose. The most common presentation of orbital fractures is associated with zygomatic complex fractures i. This is typically caused by a direct blow to the central orbit from a fist or ball. There are two broad categories of blowout fractures.
Orbital blowout fractures were experimentally created in eight human cadavers. The weakest point in this structure is the orbital floor, which makes it the most common fracture location. Orbital blow out fractures the orbit, or eye socket, is a bony opening that contains the eyeball and the muscles, blood vessels, nerves and fat that help support it. Blowout fracture american association for pediatric. An injury resulting in an increase in intraorbital pressure has blown out the floor of the left orbit with the displacement of fragments into the maxillary sinus. There are at least two theories explaining this mechanism.
A careful assessment of the orbit injury may include examination of the facial bones, eyelids, and surrounding soft tissue. The fracture of any of the orbital walls can potentially lead. Blow out fractures, or fractures of the orbital wall, are a result of either increased intraorbital pressure from blunt force leading to compression of the orbital tissue and subsequent fracture or blunt force to the orbital rim resulting in buckling of the orbital floor. Diplopia and ocular motility in orbital blowout fractures. Converse, smith, obear, and woodsmith i967, listed the automobile, the humanfist, andthe humanelbow as the mostcommonaetiological factors in a series of ioo cases. If enophthalmos is obvious at the time of presentation and the fracture is large, surgery should not be delayed. Pdf blow out fracture orbit endoscopic reduction a novel. This rare case report describes the diagnosis and treatment of an isolated leftsided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. Blowout fractures of the orbit most frequently affect the middle third of the orbit where the orbital walls are the thinnest. Internal orbital fractures of this type tend to be overlooked because of the severity of other injuries, or because they are masked by the associated swelling of the surrounding tissues. Bruising around the eye is a common symptom of a blowout fracture.
Apr 07, 2020 workup in orbital floor fractures blowout radiographs can be used for soft tissue but are limited by their lack of ability to detect differences in tissue density of less than 10%, making evaluation of soft tissue difficult at best. The characteristics of midfacial fractures and the. In 1957, smith and regan first described an orbital floor fracture with inferior rectus entrapment and subsequent restricted ocular motility as an orbital blowout fracture. Previous reports have shown blowout fracture repair beyond 2 months have worse outcomes in restoring eye motility and diplopia when compared with repair within 2 weeks from time of injury. Blowout fracture of the orbit, diplopia, surgical management protocol.
Facial fracture management handbook orbital blowout fractures anatomy and mechanism of injury. A blowout fracture occurs when there is a sudden increase in intraorbital pressure as a result of trauma to the soft tissues of the orbital area. By definition, the fracture in volves only the floor and not the orbital rim. Sep 23, 2016 common fracture sites of blowout fracture of orbit red line. The risk of enophthalmos is greatest when both the floor and the medial wall are fractured. We established positive criteria for plain film diagnosis of blow out fractures. Roentgen manifestations of blowout fracture of the orbit. Decompression then occurs by fracture of one or more of the bounding walls of the orbit. Orbital blow in fractures occur when there is displacement of bone fragments towards the orbits. Blowout fracture of the orbital floor jama otolaryngology. Traumatic injuries usually caused by assault, sports, or accidents. Diagnosis early diagnosis and treatment of a blowout fracture is extremely.
Bruising and limited eye movements secondary to swelling are common clinical presentations top. The most common intraorbital fracture is the medial wall blow out fracture. A true blowout fracture of the orbit can occur as a specific. Lateral aspect of orbital plate of maxilla absent arrow. To identify key elements in the recognition and management of a patient with an orbital blowout fracture and make recommendations on diagnosis, treatment, referral, imaging. There have been three suggested causes, as discussed in the literature for diplopia. The mechanism involved in this type of fracture was first suggested by pfeiffer i943 and later defined and proven by converse i962, converse and smith i957, i959, 1960, and smith and converse i957. Blunt force trauma to the head or around the eye can break the bones of the orbit, leading to a blowout fracture. Recognition and management of an orbital blowout fracture in. Orbital floor fractures may occur in isolation blowout fractures or as part of a zygomaticomaxillary complex fracture. Blunt force trauma to the head or around the eye can break the bones of.
Pathology blowin fracture effectively reduces the volume of the orbit associated intraorbital injuries include extraocular muscle entrapment and. Full text a case of blowout fracture of the orbital floor. The importance of examination to detect other features of orbital blowout and entrapment are stressed. Orbital fractures symptoms, diagnosis and treatment bmj. Blow out fracture repair goals of repair release trapped tissue from fracture line bring up orbital tissue from sinus into orbit cover the floor defect anatomically to restore orbital volume improve motility resolve diplopia restore volume dont hit the infraorbital nerve. Blowout fracture definition of blowout fracture by. Facial fracture management handbook orbital blowout fractures. Jason levy, in comprehensive pediatric hospital medicine, 2007. Roentgenologic manifestations of fracture of the orbital floor blowout fracture. Complete herniation of the globe through an orbital blowout fracture is uncommon.
When the blowout fracture occurs as a result of a direct injury, it is usually in conjunction with a nasoorbital fracture, which results from direct application of. Toward management consensus for diplopia in blowout. Facial fracture management handbook orbital blowout. Blow out fracture of the floor of the orbit occurs when a blow directed against the eyeball is transmitted with sufficient force to the orbital floor to rupture its weaker portions. The term blowout fracture was coined in 1957, when smith and regan 1 described the mechanism of injury.
A portion of the inferior rectus muscle solid red arrow projects into the maxillary sinus below see normal opposite sidebroken red arrow. Blow out fracture is characterized by a damage to the orbital walls with intact orbital margins and bone fragments displaced outside the orbit 2, 3. Furthermore, various complications can be seen with orbital blow out fractures. Blown out litfl medical blog ophthalmology befuddler. Outcomes of orbital blowout fracture repair performed. Many fractures of the orbit, a common occurrence with facial trauma, never require surgery, which is customarily performed in patients with restricted motility, diplopia, and enophthalmos. Orbital blowout fracture radiology reference article. The force of the blow is transmitted to the walls of the orbit, with fracture of the weakest portion fig. Citing literature number of times cited according to crossref. The most common intraorbital fracture is the medial wall blowout fracture. Commonly the bony floor of the orbit is fractured and is referred to as an orbital floor fracture. Blowout fracture of the floor of the orbit occurs when a blow directed against the eyeball is transmitted with sufficient force to the orbital floor to rupture its weaker portions.
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