Orbital blowout fracture

Blowout fracture
Other namesOrbital floor fracture
An orbital blowout fracture of the floor of the left orbit.
SpecialtyOral & Maxillofacial Surgery, ENT surgery, plastic surgery, ophthalmology
SymptomsDouble vision especially when looking up, numbness of the lateral nose skin, the cheek below the eyelid, and the upper lip, Bloody nose, lateral subconjunctival hemorrhage (bright red blood over the sclera (white of the eye))
CausesDirect trauma to the eye socket.

An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall that typically results from the impact of a blunt object larger than the orbital aperture, or eye socket.[1] Most commonly this results in a herniation of orbital contents through the orbital fractures.[1] The proximity of maxillary and ethmoidal sinus increases the susceptibility of the floor and medial wall for the orbital blowout fracture in these anatomical sites.[2] Most commonly, the inferior orbital wall, or the floor, is likely to collapse, because the bones of the roof and lateral walls are robust.[2] Although the bone forming the medial wall is the thinnest, it is buttressed by the bone separating the ethmoidal air cells.[2] The comparatively thin bone of the floor of the orbit and roof of the maxillary sinus has no support and so the inferior wall collapses mostly. Therefore, medial wall blowout fractures are the second-most common, and superior wall, or roof and lateral wall, blowout fractures are uncommon and rare, respectively. They are characterized by double vision, sunken ocular globes, and loss of sensation of the cheek and upper gums from infraorbital nerve injury.[3]

The two broad categories of blowout fractures are open door and trapdoor fractures. Open door fractures are large, displaced and comminuted, and trapdoor fractures are linear, hinged, and minimally displaced.[4] The hinged orbital blowout fracture is a fracture with an edge of the fractured bone attached on either side.[5]

In pure orbital blowout fractures, the orbital rim (the most anterior bony margin of the orbit) is preserved, but with impure fractures, the orbital rim is also injured. With the trapdoor variant, there is a high frequency of extra-ocular muscle entrapment despite minimal signs of external trauma, a phenomenon that is referred to as a "white-eyed" orbital blowout fracture.[3] The fractures can occur of pure floor, pure medial wall or combined floor and medial wall. They can occur with other injuries such as transfacial Le Fort fractures or zygomaticomaxillary complex fractures. The most common causes are assault and motor vehicle accidents. In children, the trapdoor subtype are more common.[6] Smaller fractures are associated with a higher risk of entrapment of the nerve and therefore often smaller fracture are more serious injuries. Large orbital floor fractures have less chance of restrictive strabismus due to nerve entrapment but a greater chance of enopthalmus.

There are a lot of controversies in the management of orbital fractures. the controversies debate on the topics of timing of surgery, indications for surgery, and surgical approach used.[4] Surgical intervention may be required to prevent diplopia and enophthalmos. Patients not experiencing enophthalmos or diplopia and having good extraocular mobility may be closely followed by ophthalmology without surgery.[7]

  1. ^ a b Lerman S (February 1970). "Blowout fracture of the orbit. Diagnosis and treatment". The British Journal of Ophthalmology. 54 (2): 90–98. doi:10.1136/bjo.54.2.90. PMC 1207641. PMID 5441785.
  2. ^ a b c Song WK, Lew H, Yoon JS, Oh MJ, Lee SY (February 2009). "Role of medial orbital wall morphologic properties in orbital blow-out fractures". Investigative Ophthalmology & Visual Science. 50 (2): 495–499. doi:10.1167/iovs.08-2204. PMID 18824729.
  3. ^ a b Caranci F, Cicala D, Cappabianca S, Briganti F, Brunese L, Fonio P (October 2012). "Orbital fractures: role of imaging". Seminars in Ultrasound, CT, and MR. 33 (5): 385–391. doi:10.1053/j.sult.2012.06.007. PMID 22964404.
  4. ^ a b Valencia MR, Miyazaki H, Ito M, Nishimura K, Kakizaki H, Takahashi Y (April 2021). "Radiological findings of orbital blowout fractures: a review". Orbit. 40 (2): 98–109. doi:10.1080/01676830.2020.1744670. PMID 32212885. S2CID 214681849.
  5. ^ Young SM, Kim YD, Kim SW, Jo HB, Lang SS, Cho K, Woo KI (June 2018). "Conservatively Treated Orbital Blowout Fractures: Spontaneous Radiologic Improvement". Ophthalmology. 125 (6): 938–944. doi:10.1016/j.ophtha.2017.12.015. PMID 29398084. S2CID 4700726.
  6. ^ Ellis E (November 2012). "Orbital trauma". Oral and Maxillofacial Surgery Clinics of North America. 24 (4): 629–648. doi:10.1016/j.coms.2012.07.006. PMID 22981078.
  7. ^ Flint PW, Cummings CW (2010-01-01). Otolaryngology head and neck surgery. Mosby. ISBN 9780323052832. OCLC 664324957.