orbital blow out fractures
Post on 15-Dec-2014
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ORBITAL BLOW-OUT FRACTURES
KEERTHI N S
2010 BATCH
Are isolated comminuted fractures that occur when the orbital walls are pressed indirectly
Mainly involve floor and medial wall
ETIOLOGY
Trauma by BLUNT OBJECTS like Tennis ball Cricket ball Human fist Part of automobiles
MECHANISM OF FRACTURE
Force of blow backward displacement of eyeball intraorbital pressure increases fracture in the weakest point of orbital wall
CLASSIFICATION
1. PURE BLOW-OUT FRACTURES
2. IMPURE BLOW-OUT FRACTURES
EFFECTS OF ORBITAL FLOOR FRACTURE
1. Herniation of orbital contents
2. Entrapment of inferior rectus
3. Damage to infraorbital nerve
CLINICAL FEATURES
Pain Diplopia Epistasis
SYMPTOMS
SIGNS
EARLY SIGNS Peri orbital ecchymosis Emphysema of lids Paraesthesia and anaesthesia Ipsilateral epistasis Proptosis
LATE SIGNS Enopthalmos and mechanical ptosis Diplopia
X rayCTMRI
ORBITAL IMAGING
Plain X rays
Water’s view
Findings: Fragmentation and
irregularity of orbital floor
Hanging drop opacity
Coronal Computerised tomography
CTs are diagnostic method of choice
Coronals provide best view CT can show
Herniation of fat into maxillary sinus
Magnetic resonance imaging
extraocular muscle rounding
MANAGEMENT
General measures and medical:
Avoid nasal blowing Systemic antibiotics Analgesis Anti inflammatory drugs Cold compresses
Surgical management
Indications:- Diplopia not resolving Large herniation of
tissues to antrum Retracted globe and
applanation tension Enophthalmos
Aim: To restore the continuity
of floor with or without implants(silicone rubber layer)
Time: After 10-14 days of injury
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