An Unusual Orbital Blow-out Fracture: A Case Report

Abstract

The complete dislocation of the orbital contents into the maxillary antrum as a result of trauma is an extremely rare event and requires immediate exploration and repositioning of the globe with reconstruction of the orbital floor. We present the case of a 10-year-old male who sustained trauma to the orbit and was initially suspected to have developed auto-evisceration. He underwent successful exploration and reconstruction of orbital floor with remarkable improvement.

Repositioning of a Traumatically Displaced Globe With Maxillary Antrostomy: Review of the Literature and Treatment Recommendations

“…Considering the extremely poor prognosis of PESS and the very small incidence of sympathetic ophthalmia, all efforts should be made to avoid enucleation and preserve the eye to allow the patient to recover psychologically from the accident and to maintain an acceptable cosmetic result. 8,11 …”

“…3 The use of a Caldwell-Luc approach has been previously reported. 1,3,11,15 The advantages of the Caldwell-Luc antrostomy include the increased exposure and the ability to use an inferior vector to reposition the globe. An orbital reconstructive mesh with a PTFE coating was used in our patient to restore the disrupted orbital floor.…”

“…4,6,11 Kreiner et al 4 hypothesized that treatment delays increase the risk of complications as edema and strain on the adnexal structures, specifically the optic nerve and central retinal artery, increase with time. The period that the central retinal artery is twisted or stretched further compromises the blood supply to the optic nerve, increasing the probability of irreversible vision loss.…”

“…Several investigators have reported displacement of the globe into the ethmoid sinuses and anterior cranial fossa after blunt trauma. [9][10][11][12][13] However, complete traumatic subluxation of the globe into the maxillary sinus is more probable owing to the thin orbital floor and the size and location of the maxillary sinus. The most accepted mechanism for orbital floor blowout-type fractures occurs when blunt forces to either the orbital rim or the globe itself push the orbital tissue posteriorly, causing an associated increase in the intraorbital pressure.…”

Rekonstruksi Lantai Orbita dan Dinding Anterior Maksila pada Blow Out Fracture Terbuka Tidak Murni Menggunakan Titanium Mesh Plate

“…23 Kejadian BOF tidak murni dan BOF murni adalah 3:1. 24 Blow out frakture merupakan trauma fasial paling sering terjadi karena tulang orbita yang relatif tipis.…”