A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. A fracture of the floor and medial walls of the ocular orbit caused by a blunt object, e. Abstractinferior trapdoor orbital floor fractures with muscle and soft tissue. Medial orbital wall fracture with rectus entrapment. An isolated orbital roof fracture is considered a rare finding. Note that the left orbit is intact and normal in appearance.
Orbital blowout fractures the prognostic significance of. The mechanism involved in the development of a blowout fracture generally precludes small objects as aetiological factors. If the xrays show almost no displacement then the physical signs of diplopia double vision and unequal eye placement comes becomes a judgement call. A blowout fracture occurs when the anterior orbit sustains an impact by an object of larger diameter than the orbit itself, e. In adults, orbital roof fractures are the least common orbital fracture and generally are encountered in males approximately 90% male predominance between 20 and 40 years of age after a motor vehicle.
Facial fracture management handbook orbital blowout fractures anatomy and mechanism of injury. Traumatic eye injuries knowledge for medical students. Closed globe injuries usually follow blunt trauma and have a varied clinical presentation superficial corneal abrasion to retinal hemorrhage. An orbital floor fracture or blowout fracture is most often associated with midfacial trauma ranging from mild, and almost insignificant, to severe, and debilitating. May 12, 2020 a blowout fracture is a common cranial injury in which the floor of the eye socket is cracked or shattered. Indirect orbital floor fracture blowout fracture this occurs when the bony rim of the eye remains intact, but the paper thin floor of the eye socket cracks or ruptures. Orbital blowin fractures radiology reference article. Orbital blowout fractures occur when there is a fracture of one of the walls of orbit but the orbital rim remains intact.
The patient developed unilateral eye swelling and orbital emphysema. The most common facial fracture associated with medial wall fracture was nasal. Nineteen patients with orbital floor fractures were examined and underwent computed tomography of both orbits. Orbital blowout fracture radiology reference article radiopaedia. Facial fracture management handbook orbital blowout fractures. A related situation is the whiteeyed fracture, something seen in children or young adults, said dr. It is very rare to sustain an orbital blowout fracture from blowing ones nose. This article is from journal of surgical case reports, volume 20.
Pdf fractures of the orbital floor blowout type are characterized by increased. Medial orbital wall fractures are known to occur concomitantly with floor fractures. The characteristics of midfacial fractures and the. 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. Pdf management of diplopia in patients with blowout fractures. In the treatment of blowout fractures, it is important to reconstruct and maintain.
Orbital blowin fractures occur when there is displacement of bone fragments towards the orbits. Endoscopic endonasal repair of orbital floor fracture. This article is from novemberdecember 2007 and may contain outdated material. Picture of a patient with a right orbital blowout fracture top. Immediate first aid consists of splinting the bone. Orbital fractures symptoms, diagnosis and treatment bmj. A brief comparison between this case and two others recently described is presented. Open globe injuries usually follow sharp or highvelocity blunt trauma. Anteroposterior views of the orbit usually are obtained with varying angulation of the xray beam vector.
A simple fracture is one in which there is no contact of the broken bone with the outer air, i. One of the earliest descriptions of what is now referred to as blowout fracture of the orbit was reported by lang i889. Young male suffered left zygomatic arch and orbital blowout fracture tripod fracture from blunt trauma. Orbital contents are typically forced through a fractured orbital floor blowout fracture. Many specialists encounter and treat orbital fractures. Most of the orbital cavity is comprised of very strong, resistant bone, though the floor is relatively thin and brittle. The blow causes increased intraorbital pressure fracturing its weakest part the orbital floor or medial orbital wall and not the globe itself. Recognition and management of an orbital blowout fracture. Blown out litfl medical blog ophthalmology befuddler. He underwent tripod fracture repair and orbital floor fracture repair. Full text a case of blowout fracture of the orbital. An orbital blow out fracture results from trauma to the orbit and eye area with resultant force causing fracture of the orbit into the adjacent sinuses as the orbital bones are fragile and thin. Pathology blowin fracture effectively reduces the volume of the orbit associated intraorbital injuries include extraocular muscle entrapment and. Eye trauma fracture orbital blow out treatment beverly hills.
Retroseptal transconjunctival approach for blowout. Endoscopic endonasal reduction for blowout fracture of the medial orbital wall plastic and reconstructive surgery, vol. This injury is commonly the result of a fist, baseball, or tennis ball that strikes the eye. Retroseptal transconjunctival approach for blowout fracture.
Traumatic eye injuries knowledge for medical students and. Symptoms can include orbital pain and eye movement disorders. By evaluating the amount of orbital expansion and soft tissue herniation, we were able to identify a group of patients at high risk for developing enophthalmos 37 in the group with the largest amount vs. Pdf orbital blowout fractures in sport researchgate. Blowout fracture of the orbit and what is the best treatment blowout fracture of the orbit with minimal displacement is a clinical call by the surgeon and patient.
Eye socket fracture fracture of the orbit harvard health. Considerations for the management of medial orbital wall blowout fracture. 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. Blowout fracture definition of blowout fracture by the. A case of blunt ocular trauma resulting in blowout fracture of the medial orbital wall with incarceration of the medial rectus muscle is presented. Orbital floor fractures blowout fractures clinical. However, it is important that the clinician uses the clinical examination to guide them through to the diagnosis regardless of a history of. Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. Orbital blowout fractures in sport article pdf available in british journal of sports medicine 284. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. Jan 19, 2020 an orbital blowout fracture is a fracture or breaks in the small bones that make up your eye. The most common presentation of orbital fractures is associated with zygomatic complex fractures i.
Orbital floor fractures may result when a blunt object, which is of equal or greater diameter than the orbital aperture, strikes the eye. Granick, mda a division of plastic and reconstructive surgery, rutgers new jersey medical school, newark. A fracture was considered hinged if it was still attached to an edge of the orbital bone on either side and unhinged if it was a freefloating segment. A baseball traveling 55 mph will rupture the globe of a human cadaver precisely three microseconds after impact. Nontraumatic cases of orbital blowout fractures have only been rarely described. I have right orbital floor blowout fracture with minimal. Orbital blowout fracture from nose blowing bmj case reports. Unlike the brittle bones of adults that break into pieces, childrens. We present five patients who presented with nausea and vomiting following an apparent mild head or facial injury. Some symptoms include double vision, pain with eye movements, and restriction of extraocular muscle movements. An orbital blowout fracture throughout this paper refers to fractures exhibiting displacement of the orbital floor or walls without an associated fracture of the orbital rim. To report the management outcomes of diplopia in patients with blowout fracture. An orbital blowout can occur when an object strikes the orbit with blunt force.
The force of trauma would cause an unprotected eyeball to rupture, causing permanent blindness. The eye is a highly sensitive organ that is wellprotected by the bony orbit and eyelid. Isolated medial wall fracture was most common 55 percent, followed by medial and inferior wall fracture 27 percent. Orbital floor blowout fracture statpearls ncbi bookshelf. There are few reports of blowout fractures of the orbital floor in children younger than 5 years of age. Blowout fractures of the orbit most frequently affect the middle third of the orbit where the orbital walls are the thinnest. Computed tomography is the imaging modality of choice if a blowout fracture is suspected after blunt orbital trauma. None of the five had any external evidence of injury. The decision of whether to operate an orbital blowout fracture or not is, among other things, based on the size of the fracture. This eastasian anatomical characteristic serves as an advantage when it comes to expose the orbital floor using a retroseptal approach fig. Pdf blow out fracture orbit endoscopic reduction a novel.
Before after procedure description boxer alfredo angulo suffered from upper eyelidbrow laceration during a boxing. The measurement of orbital blowout fractures cannot be. 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. Coronal ct of the patients head demonstrating the blowout fracture of the right orbit bottom. In linear fracture of the orbital floor and wall it is sufficient to free the. Blowout fracture definition of blowout fracture by. The most common intraorbital fracture is the medial wall blowout fracture. A true blowout fracture of the orbit can occur as a specific.
The goals of the orbital fracture treatment are not only to free incarcerated soft. Recognition and management of an orbital blowout fracture in. This is typically caused by a direct blow to the central orbit from a fist or ball. Orbital fractures symptoms, diagnosis and treatment. Pdf blow out fracture of orbit involves fracture of orbital floor without fracture. Orbital floor fracture blowout fracture definition. 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. An investigation into the mechanism of orbital blowout. In the repair of blowout fracture, the surgeon is free from the possibility of orbital fat exposure because its fat is already exposed out of the orbital cavity.
The most common location of the fracture is the orbital floor followed by the medial wall. 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. In greenstick fracture common in children one side of the bone is fractured and the other side bent. 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. The whiteeyed blowout, or trapdoor, fracture represents a small percentage of cases and occurs most often in children. When it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. 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. This was the third most common source in a study of 1141 blowout fractures in united states army soldiers over a 20year period.
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. Fractures of the orbital floor and the medial orbital wall blowout fractures. However, given this mechanism of injury, there is a high incidence of ocular injury. Orbital blowout fracture photos mehryar ray taban md. It is noted that this is the only case without associated global.
Orbital blowout fractures are nearly always caused by acute trauma. An orbital blow out fracture is actually a protective mechanism that functions to safeguard the eyes during trauma. A frontal bone fracture or frontal sinus fracture involves the upper edge of the eye rim, which is part of the foreheads frontal bone. Unlike the brittle bones of adults that break into pieces, childrens bones are malleable and break like green sticks lending yet another name to the fracture. 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. Reconstruction of orbital floor for treatment of a pure blowout fracture. Interesting case series isolated medial orbital wall blowout fracture aditya sood, md, mba,a samuel kogan, ba,b and mark s. Orbital blowout fracture radiology reference article. To access free multiple choice questions on this topic, click here. The white eyed blowout fracture is an orbital injury in children that is commonly initially misdiagnosed as a head injury because of predominant autonomic features and lack of softtissue signs. There are at least two theories explaining this mechanism. Blowout fracture article about blowout fracture by the.
On the basis of 90 patients with blowout fracture of the orbit the authors. A ct scan often reveals herniation of orbital fat or the inferior rectus muscle, into the maxillary sinus. Blowout fractures blowout fractures now refer to fractures of the. Here, we intend to increase the awareness of webof and provide general principles for its diagnosis. 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.
A blowout fracture is a common cranial injury in which the floor of the eye socket is cracked or shattered. Facial fracture management handbook orbital blowout. These are the so called pure blowout fractures as described by converse. There are two broad categories of blowout fractures. Blowout fracture definition of blowout fracture by medical. In order to avoid this, force is transferred to the walls around the globe. The fracture is generally the result of direct extension of a force vector into the site of fracture, or due to a transient increase in orbital or intracranial pressure that results in fracture of the orbital roof. 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. The common mechanism of injury for a superior orbital fracture is highenergy, blunt trauma to the orbit or forehead. Orbital blowout fractures are nearly always caused by trauma. It is important for the clinician to investigate all suspected orbital blowout. Pdf management of diplopia in patients with blowout.
The globe usually does not rupture, and the resultant force is transmitted throughout the orbit causing a fracture of the orbital floor. The orbit, or eye socket, is the cavity of the skull that holds the eye. Although benign in appearance, it can lead to significant patient morbidity. When called upon to assess the patient with a blowout fracture, the first step in treatment is to take a careful history and ask about the mechanism of injury. The volume and area of the fracture is often estimated using geometric figures and formulas. Jan 23, 20 physiology of blowout fracture the bony defect is filled with soft tissue and fat from the orbit alters support mechanisms for eom eom can become entrapped direct muscle damage can result 23 23. Common traumatic eye injuries occur through blunt or sharp objects or chemical burns. The common mechanisms are falls, highvelocity ballrelated.
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