Presentation
Violently assaulted to the face. There was significant left orbital swelling. A CT trauma series was performed.
Patient Data
Left orbital floor fracture demonstrated, with herniation of the orbital contents into the maxillary sinus, including the inferior rectus muscle.
Case Discussion
Orbital fractures are common, occurring in 10-25% of all cases of facial fracture1. Common mechanisms include blunt trauma, mainly from assault and motor vehicle accident.
The inferior orbital wall is most commonly affected by fracture2. Signs of orbital fracture typically include peri-ortbital bruising and subconjunctival hemorrhage. Furthermore, due to entrapment of the inferior rectus muscle, there may be restriction of downgaze in the affected eye.
Thin-sliced CT is the modality of choice in assessing orbital fracture3. Cuts should be between 2-3mm in thickness.
Management for orbital fractures is controversial3. Guidelines for surgical management include:
- Persistent diplopia after settling of initial trauma
- Enophthalmos greater than 2mm after 14 days
- Large orbital floor fracture (greater than half) and/or associated with a medial wall fracture
Case contributed by A/Prof. Pramit Phal.
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