Links to pubmed are also available for selected references. Blowout fracture of the medial orbital wall, concomitant with tissue entrapment, is a rare condition occurring in those sustaining blunt trauma. Orbital blowout fracture from nose blowing bmj case reports. This injury is commonly the result of a fist, baseball, or tennis ball that strikes the eye. Blowout fractures, or fractures of the orbital wall, are a result of either increased intraorbital pressure from.
The orbit, or eye socket, is the cavity of the skull that holds the eye. A related situation is the whiteeyed fracture, something seen in children or young adults, said dr. Late treatment of blowout fractures is dis couraging and should become something rarely encountered. It is important for the clinician to investigate all suspected orbital blowout. Blowout fracture definition of blowout fracture by medical.
There are two broad categories of blowout fractures. This article is from journal of surgical case reports, volume 20. Medial orbital wall fracture with rectus entrapment. An orbital blowout can occur when an object strikes the orbit with blunt force. This article is from novemberdecember 2007 and may contain outdated material. In the absence of trauma, this is a rare condition. Specifically, in 1844 mackenzie described maladie des yeux 9 and in 1889 lang published a report on traumatic enophthalmos. Nontraumatic cases of orbital blowout fractures have only been rarely described. To avoid missing this fracture, one must maintain a high. 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. She had symmetric visual acuity and extraocular movements were intact. Correlations between the variables were investigated. 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. Recognition and management of an orbital blowout fracture in.
In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. No other acute injuries were identified on examination. 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. Medial orbital wall fractures are known to occur concomitantly with floor fractures.
Early detection and treatment of blowout fracture of the orbit. There is a history of trauma and little sign of soft tissue injury. A blowout fracture is a fracture of the orbital floor that results from a direct blow to the orbit. Orbital fractures symptoms, diagnosis and treatment. The most common intraorbital fracture is the medial wall blowout fracture. Facial fracture management handbook orbital blowout fractures anatomy and mechanism of injury. The patient developed unilateral eye swelling and orbital emphysema.
Blowout fractures of the orbit most frequently affect the middle third of the orbit where the orbital walls are the thinnest. Medial orbital blowout fracture with entrapment jama. 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. Blowout prelom poda ocne duplje cesta je traumatska. 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.
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. 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. I will discuss new techniques and concepts of the treatment of orbital blowout fractures with particular references. None of the five had any external evidence of injury. There are few reports of blowout fractures of the orbital floor in children younger than 5 years of age. Orbital blowout fracture from nose blowing the western. Orbital blowout fractures are nearly always caused by acute trauma. A fracture of the floor and medial walls of the ocular orbit caused by a blunt object, e. Considerations for the management of medial orbital wall blowout fracture.
Facial fracture management handbook orbital blowout fractures. 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. Recognition and management of an orbital blowout fracture in an amateur boxer page a. Endoscopic endonasal reduction for blowout fracture of the medial orbital wall plastic and reconstructive surgery, vol. 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. Orbital blowout fracture radiology reference article. A blowout fracture occurs when the anterior orbit sustains an impact by an object of larger diameter than the orbit itself, e. The orbital blowout fracture is a common facial injury, carrying with it a risk of visual impairment and undesirable cosmetic results unless treated properly. Surgical treatment of orbital floor blowout fracture in. Clinical signs of swelling, ecchymosis, enophthalmos, or diplopia during medial or lateral gaze is suggestive of the condition.
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. Floor fractures may occur in combination with zygomatic arch fractures, le fort type ii or iii midface fractures, or fractures of other orbital bones the goal of treatment is to maintain or restore the best possible physiologic function and aesthetic appearance to the area of injury. The blow causes increased intraorbital pressure fracturing its weakest part the orbital floor or medial orbital wall and not the globe itself figure 3. Although benign in appearance, it can lead to significant patient morbidity. Blowout fracture a fracture of the orbit or of the school columbus state community college. Complete herniation of the globe through an orbital blowout fracture is uncommon. 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. Sep 25, 2018 green rp jr, peters dr, shore jw, et al.
Orbital floor fractures blowout fractures clinical. Aug 17, 2019 displacements of orbital walls, displacement of the globe and relative location of the fracture site were measured. Full text a case of blowout fracture of the orbital. In order to avoid this, force is transferred to the walls around the globe. Facial fracture management handbook orbital blowout. Pdf blow out fracture orbit endoscopic reduction a novel. 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 force of trauma would cause an unprotected eyeball to rupture, causing permanent blindness. Orbital floor medial wall lateral wall superior wall pure blowout fractures trapdoor rotation to bone fragments involving central area of bone impure fracture fracture line extends to orbital rim 22. Diplopia and enophthalmos after surgical repair of blowout. Clinicians should be aware that a combination of lack of soft tissue signs and presenting autonomic features. With the recent advent of accurate orbital volume assessment by computed tomography, a retrospective analysis was made of 31 patients with pure blowout fracture of the orbital floor, managed either surgically or conservatively, to determine whether orbital volume measurement could provide an additional parameter of use in the management of such fractures.
Fortytwo patients with pure orbital blowout fracture who had at least 6 months postoperative followup were included in the study group. Blowout fracture a fracture of the orbit or of the bones. Clinical signs of swelling, ecchymosis, enophthalmos, or diplopia during medial or lateral gaze is suggestive of. This rare case report describes the diagnosis and treatment of an isolated leftsided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. 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. Full text full text is available as a scanned copy of the original print version. 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 whiteeyed blowout fracture occurs almost exclusively in children and is the result of extraocular muscle entrapment in a fracture site. Get a printable copy pdf file of the complete article 1.
Purpose various materials are used in orbital blowout fracture repair. Download pdf when it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. Abstractorbital blowout fracture frequently occurs along the floor or medial aspect of the. Decompression then occurs by fracture of one or more of the bounding walls of the orbit. Orbital floor fracture with periorbital haematoma bmj case. Karsteter, maj, mpt1 craig yunker, ms, atc2 study design. Pdf fractures of the orbital floor blowout type are characterized by. We present five patients who presented with nausea and vomiting following an apparent mild head or facial injury. This is typically caused by a direct blow to the central orbit from a fist or ball. 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. Facial skeleton fractures can result from low, medium, or highvelocity trauma. 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.
Orbital volume measurement in the management of pure. Optimal timing of the surgical treatment is still a matter of debate. Orbital floor fracture with periorbital haematoma bmj. However, given this mechanism of injury, there is a high incidence of ocular injury. Medpor porous polyethylene implants in orbital blowout. Blowout fracture a fracture of the orbit or of the bones that support the floor. Blowout fracture of the orbit american journal of ophthalmology. 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. Displacements of orbital walls, displacement of the globe and relative location of the fracture site were measured. Prediction of late displacement of the globe in orbital. 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. Orbital blowout fractures are usually the result of a direct blow to the orbit, which causes a sudden increase in intraorbital pressure. The characteristics of midfacial fractures and the.
Jan 19, 2020 an orbital blowout fracture is a fracture or breaks in the small bones that make up your eye. 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. Endoscopic endonasal repair of orbital floor fracture. Anteroposterior views of the orbit usually are obtained with varying angulation of the xray beam vector. Orbital blowout fractures occur when there is a fracture of one of the walls of orbit but the orbital rim remains intact.
Clinically, blowout fractures may show laceration and abrasion of the lids with. An investigation into the mechanism oforbital blowout fractures. An isolated orbital roof fracture is considered a rare finding. The blow causes increased intraorbital pressure fracturing its weakest part the orbital floor or medial orbital wall and not the globe itself. The common mechanism of injury for a superior orbital fracture is highenergy, blunt trauma to the orbit or forehead. If the xrays show almost no displacement then the physical signs of diplopia double vision and unequal eye placement comes becomes a judgement call. This was the third most common source in a study of 1141 blowout fractures in united states army soldiers over a 20year period.
Immediate first aid consists of splinting the bone. The diagnosis and management of orbital blowout fractures. Internal orbital fractures in the pediatric age group. Here, we intend to increase the awareness of webof and provide general principles for its diagnosis. Isolated trapdoortype medial blowout fracture in an adult. An orbital blow out fracture is actually a protective mechanism that functions to safeguard the eyes during trauma. Pdf orbital blowout fractures in sport researchgate. Full text is available as a scanned copy of the original print version. I have right orbital floor blowout fracture with minimal. Cureus orbital blowout fracture with complete dislocation. Blowout fracture definition of blowout fracture by.
A baseball traveling 55 mph will rupture the globe of a human cadaver precisely three microseconds after impact. This subset, whiteeyed blowout, usually occurs in patients under 18 years of age. The most common presentation of orbital fractures is associated with zygomatic complex fractures i. We set out to determine whether a metaanalysis would bring us closer to an answer to this question. Pdf blow out fracture of orbit involves fracture of orbital floor without. We describe a series of patients with orbital blowout fractures that were repaired using porous polyethylene medpor sheets. Blowout fractures blowout fractures now refer to fractures of the. Orbital emphysema is usually secondary to traumatic orbital fracture. Biomaterials for repair of orbital floor blowout fractures.
Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim. Download fulltext pdf orbital blowout fractures in sport article pdf available in british journal of sports medicine 284. Although the causative trauma is usually substantial, presentation and diagnosis may be delayed in the setting of. Recognition and management of an orbital blowout fracture. May 02, 2020 orbital emphysema is usually secondary to traumatic orbital fracture. Blowout fractures are caused by increased pressure in the orbit the orbit gives way at its weakest point, which is the orbital floor. The mechanism involved in the development of a blowout fracture generally precludes small objects as aetiological factors. A ct scan of the orbits showed a right orbital floor fracture measuring 1. Pdf update in treatment of orbital blowout fractures.