Left orbital floor fracture with herniation

Case contributed by Dr Dayu Gai

Presentation

This 25 year old male was violently assaulted to the face. There was significant left orbital swelling. A CT trauma series was performed.

Patient Data

Age: 25
Gender: Male
Modality: CT

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 haemorrhage. 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:

  1. Persistent diplopia after settling of initial trauma
  2. Enophthalmos greater than 2mm after 14 days
  3. 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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Case Information

rID: 32046
Case created: 11th Nov 2014
Last edited: 29th Feb 2016
System: Head & Neck
Inclusion in quiz mode: Included

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