Camel-related maxillofacial injuries: retrospective study of seven patients

Abstract

Background: A medically fit and well 34-year-old female patient initially presented to the emergency department at Queens Medical Centre following an accident in which she fell from her bike and hit the left orbit with handlebar. Plain film radiographs (OM10o and 30o) showed no evidence of any facial fractures. Clinically, she had no functional problems apart from diplopia on lateral gaze associated with left eye. A two-week review was planned by ophthalmology. Objectives: Patient attended eye causality department 7 days after the initial trauma complaining of ongoing restriction of movement. Ophthalmological examination revealed restricted ocular motility and diplopia on all directions of gaze particularly downwards. Methods: A computed tomography (CT) scan performed to investigate the cause of restriction revealed an orbital roof fracture. Following discussion with neurosurgery a magnetic resonance imaging (MRI) was arranged to exclude abscess. Findings: CT showed blowout fracture through the superamedial left orbital cavity with displaced fragments projected 2 cm into the left frontal lobe. Subsequent MRI scan showed abscess formation around the left frontal lobe. The patient had urgent bifrontal craniotomy and drainage of the abscess. Due to risk of infection, no roof repair was performed. Conclusion: This case emphasised the importance of multidisciplinary approach in trauma cases; in this scenario the patient was managed by the maxillofacial surgical team, neurosurgery and ophthalmology. This case also highlights the need for consideration of mechanism of injury in light of clinical findings. A penetrating injury should always make the surgeon consider and exclude underlying bony injury.