Presentation
Patient presented to hospital after being assaulted. He was punched and kicked numerous times to the face. Nil LOC or symptoms of increased intracranial pressure. On examination, he had significant swelling around the left periorbital and maxillary region with marked tenderness in these regions as well.
Patient Data
There is a depression of the left orbital floor in keeping with an undisplaced fracture and a pathognomoniic "teardrop sign" is present.
Additional minimally displaced fracture seen at the lateral wall of the left maxillary sinus with an air-fluid level in the left maxillary sinus
Corresponding CT head confirming left orbital blowout fracture (best viewed on the coronal bone window) as well as the marked extent of soft tissue swelling seen on other projections.
Case Discussion
The teardrop sign can sometimes be seen on plain radiographs in the case of an orbital blowout fracture involving the orbital floor. It is a polypoid soft tissue opacity seen hanging from the orbital floor into the maxillary antrum and represents inferior herniation of orbital contents, i.e. periorbital fat and the inferior rectus muscle.