Superior orbital roof blowout fracture with intact orbital rim
Street altercation and punch to face.
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Coronal and sagittal CT images illustrate isolated superior orbital roof blowout fracture with an intact orbital rim. The superior orbital roof is elevated with an acute conal/extraconal haematoma involving the superior rectus/levator palpebrae superioris muscles and contusion of the orbital gyrus of the right frontal lobe. Marked periorbital soft tissue haematoma and a minimally displaced right nasal bone is also noted.
This particular pattern of injury is rarely reported. An academic observation is the asymmetric, poorly pneumatised right frontal sinus and the prominent supraorbital ridge. These factors may have served to protected the orbital rim leading to altered transmission of force through the weaker superior orbital roof. It is uncertain why the paper thin lamina papyracea remains intact but maybe due to the direction of the transmitted force.