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. These fractures occur due to a huge amount of force, and because of this force, patient also experiences extensive injuries to other facial bones, and sometimes even injuries to the brain. Classification and epidemiology of orbital fractures diagnosed by computed tomography 140 rev. Orbital blowout fracture photos mehryar ray taban md. Recognition and management of an orbital blowout fracture. The management of these fractures is often challenging due. For surgical purposes, the bony orbit is divided into the orbital frame and the orbital walls, both subunits. Usually this kind of injury is caused by blunt force trauma, when something hits the eye very hard. Jun 11, 2010 of orbital fractures, the inferior wall is most commonly involved, followed by the medial wall. However, it can occur even with nondisplaced orbital fractures. Computed tomography is the technique of choice to evaluate complex fractures of the orbit because it can show displacement of bone fragments, injury to the orbital muscles or nerves, and intracraneal involment which are often not measurable with conventional radiology. If you continue browsing the site, you agree to the use of cookies on this website. The patient reported to the athletic training room 15 minutes after completing a. Tutorial level 3 orbital fracture classification system.
Reconstruction of medial orbital wall fractures without. Common fracture sites of blowout fracture of orbit red line. Because a great deal of force is required to cause these fractures, they often occur with extensive injuries. Orbital floor blowout fractures causing softtissue entrapment can exacerbate the oculovagal response and require urgent surgical intervention. These occur as a result of direct impact to the face, often in car crashes from the face being hit into the steering wheel or an automobile dashboard. Orbital fractures an overview pavan kumar b1, yashwanthyadav2, brahmaji rao3, haripriya chari4 abstract. The initial use of endoscopic techniques in the diagnosis and management of orbital fractures can be traced to the 1970s, when westphal and kreidler described sinusoscopy for the diagnosis of blowout fractures. Orbital fractures long island orbital trauma sightmd. Classification and epidemiology of orbital fractures diagnosed by.
This book on orbital fractures is one of the most comprehensive. Other serious eye injuries can be present at the same time, including bleeding or inflammation inside the eyeball itself, or even rupture or laceration of the eyeball, and so a careful examination is very important. An orbital fracture usually occurs after some type of injury or a strike to the face. He underwent orbital fracture surgery with implant placement through hidden inside eyelid, conjunctiva incision. Patients with an orbital injury require initial evaluation by the emergency department ed physician and in some cases activation of the trauma team following current advanced trauma life support atls protocols see chapter 74. The mechanism of injury is a direct blow to the orbital rim or orbit. There are two broad categories of blowout fractures. This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007. Most thin portions of the orbit is medial to the infraorbital groove. Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis. Classification and epidemiology of orbital fractures.
Recognition and management of an orbital blowout fracture in. Orbital fractures can often be diagnosed during a meticulous examination by an eye doctor or an emergency room physician. May, 2019 direct orbital floor fracture if an orbital rim fracture extends into nearby parts of the eye socket floor, both the rim and the socket floor are fractured. Fracture severity ranges from small minimally displaced fractures of an isolated wall that require no surgical intervention to major disruption of the orbit as seen in the images below. Several technologic advances have occurred in the last 3 decades that have had a significant impact on the management of patients with orbital injuries, including the following. Orbital roof and frontal fractures are more common in this younger age group, and blowout fractures of the floor are rare in children under five. Immediate management is essential in preventing complications. Jun 03, 2016 orbital roof fractures may be directly accessed and repaired using a frontal craniotomy and brain retraction. Orbital fractures may be isolated, or combined, with other nonorbital injuries head, neck, and spine. Oral and maxillofacial fractures are common injuries among multiple trauma patients. Most surgeons describe the orbital fracture according to the location within the orbit floor, medial wall, lateral wall, and roof. Karsteter, maj, mpt1 craig yunker, ms, atc2 study design. The oculovagal reflex refers to the presence of vagal stimulation by pressure to intraorbital structures, which results in bradycardia, hypotension, and nausea andor vomiting. Sep 27, 2014 fractures of the orbital region have an incidence of 1025% from the total facial fractures and the most common age group was the third decade of life 29%.
Jun 20, 2008 orbital fractures orbital blowout fractures christina gillespie, md slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Whereas an impure fracture involves the orbital rim and adjacent facial bones. They occur when the thin floor of the eye socket cracks, leaving the rim unaffected. An algorithm for the treatment of isolated zygomaticoorbital. 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. Orbital blowout fractures are uncommon but important injuries for physical therapists to recognize. The crack or hole in the orbital floor can trap eye muscles and surrounding tissues, impeding.
May 24, 2016 orbital fractures occur both as isolated injuries and in conjunction with additional maxillofacial fractures or multisystem trauma. Knowledge of the potential injuries to the eye and their imaging correlates is essential to making an accurate and rapid radiologic diagnosis of posttraumatic orbital injury. What is the treatment for orbital fracture and its healing time. Recognition and management of an orbital blowout fracture in an amateur boxer page a. A fracture is a broken bone in the eye socket involving the rim, the floor or both.
When it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. The opposite is true of large fractures of the orbital floor. An orbital rim fracture typically occurs with extensive injury or when an object directly impacts the face. The globe usually does not rupture, and the resultant force is transmitted throughout the orbit causing a fracture of the orbital floor. This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical followup, particularly with regard to postoperative complications. Diagnosis and treatment of orbital wall fractures are based on both physical examination. In facial wounds, tear ducts and nerves of the face may be damaged.
Orbital fractures may involve the rim of the eye socket, its floor, or both areas of the socket. A pure blowout fracture of the orbit does not involve the orbital rim. Mvarelated orbital fractures, in particular, tend to be more destructive and are associated with more concomitant organ injuries, zygoma fractures, and multiple orbital wall fractures than the other common causes of assault, sportsrelated, falls, and so forth. Cmf midface and orbital floor complex fractures fixation with the matrixmidface system duration. What is the treatment for orbital fracture and its healing. Orbital fractures occur both as isolated injuries and in conjunction with additional maxillofacial fractures or multisystem trauma.
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. This is caused by atrophy of the orbital fat andor muscles. Other facial fractures in adults and children are discussed separately. Orbital fracture treatment denver orbital fracture repair. The most common etiology seems to be violent assault or nonviolent traumatic injury 49. For example, fractures of the orbital floor or medial orbital wall of the eye can entrap the medial rectus or inferior rectus muscles. Sep 28, 2017 an orbital fracture is when there is a break in one of the bones surrounding the eyeball called the orbit, or eye socket. Apr 27, 2010 however, the greatest long term concern is what is termed enophthalmos, or sinking in of the affected eye. A, severe midfacial and orbital fractures resulting in orbital dystopia, telecanthus, and cranial neuropathy. Orbital wall fractures, especially in concert with ich 1 2 2 1 1 and other cranial fractures, are among the most complex to reconstruct.
When one or more bones surrounding the eye are broken, the condition is called orbital fracture. Of the various maxillofacial fractures, orbital fractures involve one of the most complex anatomy resulting in a variety of both esthetic and functional disturbances, often associated with other complex fractures. A current 10year retrospective survey of 199 surgically treated orbital floor fractures in a nonurban tertiary care center. Apr 01, 2019 treatment for orbital fracture comprises of surgery in severe cases and ice packs, rest and antibiotics in mild fractures. Aug 24, 2016 orbital fractures occur in about 1025% of all facial fracture cases. Sometimes the eye muscles can become trapped in the fracture making it difficult to move the eye and causing double vision as a result. The mission of asoprs is to advance education, research, and the quality of clinical practice in the fields of aesthetic, plastic and reconstructive surgery specializing in the face, orbits, eyelids and lacrimal system. Apr 25, 2018 orbital fractures are commonly seen with midfacial trauma. Many specialists encounter and treat orbital fractures. Nov 17, 2015 most orbital fractures occur in males in their second decade of life. Also known as blowout fractures, these are the most common type of orbital trauma. About 85% of traumatic eye injuries, including eye socket fractures, happen by accident, during contact sports, at work, in car crashes or while doing home repair projects. Get your kindle here, or download a free kindle reading app.
The causes of orbital fractures vary, but assault is the most frequent. 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. Operative strategies are dictated by the portion of orbit. An orbital fracture is a break in one of the bones, most commonly, the one beneath the eye, called the orbital floor.
Results restoration of the normal orbital cavity shape was confirmed by examining the postoperative ct scans. Other causes include motor vehicle crash, falls especially in the elderly, sports and industrial accidents. Orbital fractures nsw agency for clinical innovation. It is caused by a sudden increase in the orbital pressure by a striking object which is greater than 5 cm in diameter. Orbital rim fracture these are caused by a direct impact to the face, most commonly by an automobile dashboard or steering wheel during a car crash. Young boy, with right orbital blow out fracture secondary to golf ball injury with inability to move the right eye up left photo. Trauma to the eye accounts for approximately 3% of all emergency department visits in the united states, 1. See initial evaluation and management of facial trauma in adults. Orbital fractures are a consequence of middle third facial trauma and occur as a result of the application of forces that overcome the resistance of bone structures.
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