Relative contraindication are reserved for ocular injuries, such as hyphema, globe perforation, and retinal tears. Most surgeons agree that a 2×2-cm defect or defects larger than 50% of the wall behind the equator of the globe is most likely to cause clinically significant enophthalmos (greater than 2 mm), and these patients are candidates for surgical repair. In recent literature, early surgical repair has been recommended because it was associated with better outcomes. The severity of these conditions dictates the need for an observation period of about 2 weeks. Enophthalmos or hypoglobusis are commonly encountered. Īesthetic indications for surgical interventions involve globe malposition. In addition, VC-EOM could also occur in orbital compartment syndrome, in elderly patients who are hypotensive, and in those with small-fracture diplopia. Because of this, white-eyed blowout fracture is considered a surgical emergency and warrants operative intervention within 24 hours of injury. With white-eyed blowout fracture, ischemia can cause permanent damage to the involved EOM with resultant Volkmann contracture of extraocular muscles (VC-EOM). This clinical presentation is referred as the white-eyed blowout fracture (age <18 years), which involves a history of periorbital trauma, little ecchymosis or edema (lack of black eye), but marked EOM restriction. In the pediatric population, the bony elasticity allows the fracture to open and close back into position, tightly trapping the periorbital tissue or EOMs. Because of potential significant discomfort, this should be performed under sedation or anesthesia.
ORBITAL FRACTURE FULL
The examiner uses forceps to grasp the conjunctiva near the attachment of the inferior rectus muscle and attempts to move the globe through a full range of motion. 1).įorced duction test should be performed to evaluate extraocular muscle entrapment. This complicated anatomy makes repair and reconstruction of orbital fracture difficult for a novice ( Fig. The orbital floor, which forms the roof of the maxillary sinus, slopes upward toward the apex of the pyramid, which lies roughly 44 to 50 mm posterior to the orbital entrance. The orbital cavity is itself bound by the orbital roof, lateral and medial walls, and orbital floor. The outer rim of the orbit is comprised of the first three robust bony elements, protecting the more delicate internal bones of the orbital cavity.
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The ethmoid, frontal, and maxillary bones–closely related to sinus pneumatization–act as shock absorbers for the eye globe. Seven facial bones make up the bony orbit: the frontal, maxilla, zygoma, ethmoid, lacrimal, greater and lesser wings of the sphenoid, and palatine bones. Isolated orbital fractures are encountered in 4%-to-16% of all facial fractures, and orbital fractures compose 30%–55% of zygomatic complex and naso-orbital-ethmoid fractures. Fractures of the orbit are common yet challenging to manage.