Orbital fractures symptoms, diagnosis and treatment bmj. Pdf onethird of orbital blowout fractures are sustained during sport. Complete understanding of the pathologic anatomy of the orbitoantral partition, coupled with diagnostic familiarity and surgical facility on either side of this partition, will lead to correct therapy. Fractures commonly happen because of car accidents, falls, or sports injuries. That is, a golf ball striking the globe would usually result in a rupture ofthe globe rather than a blowout fracture, butalarger object, such as a fist, aknee, adashboard, etc. A related situation is the whiteeyed fracture, something seen in children or young adults, said dr. Full text a case of blowout fracture of the orbital floor. We report a case of a 27 years old man, who was diagnosed with a pure blowout fracture after a physical aggression.
A blowout fracture is a fracture of one or more of the bones surrounding the eye. Leforte, lagrange, and others believe that the force is transmitted by bone con duction through the rigid orbital rim directly to the thin orbital floor. Results a single surgeon performed all surgeries between october 2000 and april 2008. If the broken bone punctures the skin, it is called an open or compound fracture. The terms pure and impure have been used to describe isolated orbital fractures pure versus orbital fractures that occur in conjunction with other fractures impure. The floor of the orbit is the weakest portion of this 4sided pyramid structure. Diplopia and enophthalmos after surgical repair of blowout. Overuse can cause stress fractures, which are very small cracks in the bone. British journal of plastic surgery 1999, 52, 607612. Radiological findings of orbital blowout fractures. Subtle diagnostic markers of orbital floor blowout fracture. Injuries to the eye itself may also be sustained and should be looked for. Please note, due to essential maintenance online purchasing will not be possible between 03. One of the things we see with orbital floor fractures, what we call a blowout fracture, is that the eyeball itself is often the conduit of force, said jon m.
Orbital blow out fracture ki open archive karolinska institutet. Among facial fractures, orbital blowout injuries most often involve. The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The whiteeyed blowout fracture webof is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features.
Medial orbital wall fractures are known to occur concomitantly with floor fractures. Here, we intend to increase the awareness of webof and provide general principles for its diagnosis. Pdf blow out fracture of orbit involves fracture of orbital floor without fracture of. The distribution of orbital blowout fracture sites, the ratio of single or multiple fracture sites, and the causes of injury were statistically different among the age groups p 0. Objectivethe orbital blowout fracture is a common facial injury, carrying with it a risk of visual impairment and undesirable cosmetic results unless treated properly. To evaluate the incidence of residual diplopia and enophthalmos and the possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. The preoperative and postoperative true coronal computed tomography ct scans of 58 patients with unilateral pure orbital blowout fractures were included in the study. Surgical treatment of orbital floor blowout fracture in. Are sonographic characteristics associated with progression to surgery in men with peyronies diseas. Blowout fracture of the orbit american journal of ophthalmology.
Blunt force trauma is the primary mechanism of injury in young men between the ages of 18 and 30 years. Orbital fractures are one of the most commonly seen facial fractures, caused by blunt trauma in road traffic accicents. The most common intraorbital fracture is the medial wall blowout fracture. Reconstruction of orbital floor for treatment of a pure. The characteristics of midfacial fractures and the. Clinicians should be aware that a combination of lack of soft tissue signs and presenting autonomic features such as nausea and vomiting could distract from the. There is a history of trauma and little sign of soft tissue injury. Bruising around the eye is a common symptom of a blowout fracture. Blowout fracture american association for pediatric. This was the third most common source in a study of 1141 blowout fractures in united states army soldiers over a 20year period. Orbital blowout fractures are relatively rare in patients under 18 years of age, but may lead to serious complications. Trauma to the face, especially near the eye, oftentimes results in a blowout fracture.
A case of blowout fracture of the orbital floor in early. On followup the next day, after determining that the radiographs were normal, but still having a high index of suspicion for an orbital blowout fracture, we referred him to his primary care manager. Get a printable copy pdf file of the complete article 1. Blowout fractures of the orbit most frequently affect the middle third of the orbit where the orbital walls are the thinnest. Severe orbital infection as a complication of orbital fracture. Nontraumatic cases of orbital blowout fractures have only been rarely described. Backgroundaim to describe the features and outcomes of orbital blowout fracture surgery in children and adolescents blowout fracture surgery at a tertiary referral hospital. The most common presentation of orbital fractures is associated with zygomatic complex fractures i. Orbital blowout fracture from nose blowing bmj case reports. Nausea and vomiting in children who have minimal signs of trauma and no loss of consciousness has been found to be a presenting sign of orbital fracture in up to 55. The patient developed unilateral eye swelling and orbital emphysema. Blowout fracture of the british journal of ophthalmology. Assessment of internal orbital reconstructions for pure. 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. This subset, whiteeyed blowout, usually occurs in patients under 18 years of age. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. Intravenous cefotaximesodium and vancomycintherapywas initiated.
They can occur with other injuries such as transfacial le fort fractures or zygomaticomaxillary complex fractures. Facial fracture management handbook orbital blowout fractures anatomy and mechanism of injury. It outlines the theories on the mechanism of blowout fracture and concludes that it is most likely caused by a combination of bone and global force transmission. Orbital blow out fracture to operate or not to operate that is the question. Recognition and management of an orbital blowout fracture. There are few reports of blowout fractures of the orbital floor in children younger than 5 years of age. Orbital blowout fracture radiology reference article. The floor of the orbit gets affected more commonly than the other walls. Orbital blowout fractures are nearly always caused by acute trauma. The term blowout fracture was coined in 1957, when smith and regan. Occurs when small object strikes globe directly, without causing orbital ridge or rim fracture. They have a blowout, with entrapment, but perhaps without many signs, such as swelling, ecchymosis or hemorrhageso the eye is white and quiet even in the presence of a fracture.
This type of fracture must be distinguished from an. Pathology blowin fracture effectively reduces the volume of the orbit associated intraorbital injuries include extraocular muscle entrapment and. Britishjournal ophthalmology orbital volume measurement. Subtle diagnostic markers of orbital floor blowout. We conducted this retrospective study to evaluate diplopia, clinical characteristics, and postoperative results in cases of orbital blowout fractures in the pediatric population. 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. Tabakovic, ivana ilic dimitrijevic clinic of maxillofacial surgery, department of dentistry, faculty of medicine, university of prishtina with temporary seat in kosovska mitrovica, kosovska. The mechanism involved in this type of fracture was first suggested by pfeiffer i943 and later defined and proven by converse i962, converse. Clinicians should be aware that a combination of lack of soft tissue signs and presenting autonomic features. This study aims to evaluate the ability of an automatic orbital blowout fractures detection system based on computed tomography ct data.
Request pdf radiological findings of orbital blowout fractures. There are two broad categories of blowout fractures. Orbital blowin fractures occur when there is displacement of bone fragments towards the orbits. This is typically caused by a direct blow to the central orbit from a fist or ball. A search of the pubmed database using the term, pediatric blowout fractures or blowout fractures in children, revealed only six reports, in which. Recognition and management of an orbital blowout fracture in an amateur boxer next. Commonly the bony floor of the orbit is fractured and is referred to as an orbital floor fracture. The globe usually does not rupture, and the resultant force is transmitted throughout the orbit causing a fracture of the orbital floor. Overuse can cause stress fractures, which are very. Limitation of inferior rectus muscle mobility is thought to be a result of muscle kinking associated with orbital fatpad prolapse at the fracture site, rather than muscle incarceration.
The formative study by putterman et al6 regarding the natural history of unoperated blowout fractures found that diplopia resolved in all patients within 6 months. Clinical signs of swelling, ecchymosis, enophthalmos, or diplopia during medial or lateral gaze is suggestive of. Comparison of the outcomes of nontrapdoortype blowout fracture repair according to the time of surgery. Orbital blowout fractures in children require more swift intervention than in adults if muscle ischaemia and permanent impairment of the vision is to be avoided. Braverman, md, associate clinical professor of ophthalmology at the university of colorado in denver. Sep 25, 2018 orbital floor fractures may result when a blunt object, which is of equal or greater diameter than the orbital aperture, strikes the eye.
In order to avoid this, force is transferred to the walls around the globe. Facial fracture management handbook orbital blowout. Silent sinus syndrome a blowout fracture mimic chanabasappa chavadi 1, swetha kory 2, ajit mahale 1, merwyn fernandes 1 from the department of radiodiagnosis, kasturba medical college 1, mangalore. Although benign in appearance, it can lead to significant patient morbidity. Pdf orbital floor fractures top journal best impact. The whiteeyed blowout, or trapdoor, fracture represents a small percentage of cases and. Blowout fracture of the medial orbital wall, concomitant with tissue entrapment, is a rare condition occurring in those sustaining blunt trauma. Sep 23, 2016 because of this, whiteeyed blowout fracture is considered a surgical emergency and warrants operative intervention within 24 hours of injury. In addition, vceom could also occur in orbital compartment syndrome, in elderly patients who are hypotensive, and in those with small fracture diplopia. Orbital blowout fractures the american journal of emergency. Orbital fractures symptoms, diagnosis and treatment. A blowout fracture is caused by a traumatic force applied to the orbital rim or globe and usually results in a sudden increase in intraorbital pressure. Orbital blowout fractures are one of the most common occurring facial bone injuries.
An investigation into the mechanism oforbital blowout fractures. Conservatively treated orbital blowout fractures ophthalmology. Blowout fracture definition of blowout fracture by medical. A case report hirursko lecenje blowout preloma poda ocne duplje kod dece sasa z. Trapdoor fracture is a special type of fracture found especially in children, and can often include muscle and soft tissue injury. With the trapdoor variant, there is a high frequency of extraocular muscle entrapment, despite minimal signs of external trauma, a phenomenon referred to as a whiteeyed orbital blowout fracture. The blowout fracture is the most common type of orbital fracture that confronts the ophthalmic surgeon. Burnstine advocated urgent repair for trapdoor fractures with entrapment of an extraocular muscle by the fracture fragment and marked restrictions of vertical gaze. To summarize the radiological findings in patients with orbital blowout fractures. Onethird of orbital blowout fractures are sustained during sport.
An investigation into their anatomical basis volume 81 issue 10 d. Recognition and management of an orbital blowout fracture in. Bruising and limited eye movements secondary to swelling are common clinical presentations top. British journal of oral and maxillofacial surgery 2000 38, 496503. An orbital blow out fracture is actually a protective mechanism that functions to safeguard the eyes during trauma. The whiteeyed blowout fracture occurs almost exclusively in children and is the result of extraocular muscle entrapment in a fracture site. Based on a recent case in which a patient presentedto our institution with severe orbital infection that developed after an orbital blowout fracture, the followingquestionswere raised. Demographics and surgical outcomes abstract objectives.
Subtle diagnostic markers of orbital floor blowout fracture on coronal ct scan volume 107 issue 2 julian m. Fortytwo patients with pure orbital blowout fracture who had at least 6 months postoperative followup were included in the study group. The ophthalmologist must be aware of the events and sites of injury to the optic nerve which lead to visual. Global journal of otolaryngology issn 24747556 orbital blowout fractures in manitoba. The force of trauma would cause an unprotected eyeball to rupture, causing permanent blindness.
Whiteeyed medial wall blowout fracture mimicking head. One of the earliest descriptions of what is now referred to as blowout fracture of the orbit was reported by lang i889. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Ct scan demonstrates common findings of a blow out fracture with evidence of. Similarly, kasaee et al15 found in 72 patients with blowout fractures followed up. Journal of surgical case reports, volume 20, issue 7, july 20, rjt054. Medial orbital blowout fracture with entrapment jama. Blindness following blowout fractures is an unfortunate complication. The sudden increase in intraocular pressure which leads to orbital fracture can. The orbital floor blowout fracture is characterized by the involvement of only the wall of the orbit with an intact orbital rim 1 after blunt trauma. Orbital blow out fracture is a common disease in emergency department and a delay or failure in diagnosis can lead to permanent visual changes. Endoscopic endonasal repair of orbital floor fracture. Pdf orbital blowout fractures in sport researchgate.
Patients with whiteeyed medial wall blowout fracture with muscle entrapment can present with oculocardiac reflex symptoms, pain, diplopia, and strabismus in the absence of any signs on ocular examination except for abnormal motility. Orbital floor fractures blowout fractures clinical. Ent scholar is an associate journal of webmedcentral. The mechanism involved in the development of a blowout fracture generally precludes small objects as aetiological factors. Steroids and orbital blowout fractures a new systematic concept in medical management and surgical decisionmaking. We suspected an orbital blowout fracture and referred him immediately to the emergency department where conventional radiographs were ordered. Orbital floor fractures may result when a blunt object, which is of equal or greater diameter than the orbital aperture, strikes the eye. The incompressible intraorbital contents are displaced posteriorly, and the traumatic force is transmitted to the thin orbital floor and medial orbital wall, which are the first to fracture. An orbital blowout fracture can occur in isolation or as a more complex craniofacial fracture pattern. Journal of pediatric ophthalmology and strabismus introductionfollowing orbital trauma, a blowout fracture is one of the most important causes of vertical diplopia.
The management of orbital blowout fractures is controversial. The term pure blowout is used to refer to a fracture ofthe floor or medial wall ofthe orbit without a fracture of the orbital rim. Surgical treatment of orbital floor blowout fracture in children. The delay for head injury observation may therefore compromise the surgical outcome. Similarly, kasaee et al15 found in 72 patients with blowout fractures followed up without surgery that. Orbital floor fractures may occur in isolation blowout fractures or as part of a zygomaticomaxillary complex fracture. Though visual acuity recovery is usually complete, permanent loss of binocular visual field is almost universal. How do i know if i have an orbital blowout fracture, and when should i see a doctor. Orbital blowin fractures radiology reference article.
A case of blowout fracture of the orbital floor in early childhood ncbi. Orbital blowout fractures in sport article pdf available in british journal of sports medicine 284. Blowout fractures should be evaluated by computed tomographic computer reformations in the oblique sagittal plane. It is important for the clinician to investigate all suspected orbital blowout. They can be readily diagnosed and successfully treated. The cause of injury, clinical presentation, and management of orbital blowout fractures in adults have also been described. Typically highenergy blows by opponents finger, fist, elbow, knee or boot are responsible. Full text full text is available as a scanned copy of the original print version.
A true blowout fracture of the orbit can occur as a specific. A case of blowout fracture of the orbital floor in early childhood akira sugamata, naoki yoshizawadepartment of plastic and reconstructive surgery, tokyo medical university hachioji medical center, tokyo, japanabstract. All cases of orbital trauma or suspected orbital blow out fracture should be promptly evaluated by a facial trauma specialist. Blunt orbital trauma commonly results in a blowout fracture of the orbital floor or medial wall.
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. Whether the orbit reconstruction is indicated, natural and synthetic materials are available. Links to pubmed are also available for selected references. Computer tomography scan is a helpful method for the diagnosis and qualification of this fracture. Force is transmitted through globe and results in fracture of the fragile inferior or medial orbital walls pure blowout fracture isolated fracture of orbital walls. These fractures maycause entrapment oforbital soft tissue structures with resulting enophthalmos and limitation of vertical or horizontal ocular motility. To assess the adequacy of internal orbital reconstruction in pure blowout fractures using either cranial bone grafts or titanium mesh implants. Pdf blow out fracture orbit endoscopic reduction a novel. To recommend a tailored approach to surgical timing in the repair of orbital blowout fractures, and to offer suggestions for improved functional and aesthetic surgical outcomes.
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