Medial wall fracture- induced pneumo-orbita mimicking inferior rectus entrapment

Burt, Ben; Jamieson, Michael; Sloan, Brian

doi:10.1016/j.ajem.2009.04.040

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…Pathological presence of the air in soft tissues of the orbit ( orbital emphysema, pneumoorbita ), eyelids, or the face is commonly caused by different types of bone fractures including blowout fracture [ 7 – 10 ]. According to Key et al [ 11 ] up to 50% of the cases of blowout fracture are accompanied by orbital emphysema (the air may collect in the preseptal or retroseptal regions of the orbit or subcutaneously).…”

Section: Discussionmentioning

confidence: 99%

“…In order for the air to escape from the sinuses to other regions a force there must appear either pushing it out or sucking in into surrounding tissues. The air can be compressed in the sinuses on condition that their natural openings are obstructed, for example, in case of infection or trauma, and it exits the sinus through a natural defect in its wall or a posttraumatic fissure [ 7 , 14 , 15 ]. In case of normal sinus openings the air pressure in the sinuses may elevate during vomiting, coughing, or sneezing or when an individual is subjected to a high external pressure, for example, in case of diving or travelling by plane [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The valve mechanism leads to the increase of pressure in the orbital tissues above 65–70 mm Hg, which prevents blood from flowing through the middle retinal artery (in the research using animals this pressure reaches 105 mm Hg [ 17 , 18 ]). Burt et al [ 7 ] described posttraumatic deterioration of the eyeball movement due to the impression of the collected air spaces in the orbit. The treatment in case of orbital emphysema accompanied by increasing symptoms (especially deterioration of vision) should include one of the procedures: lateral canthotomy, inferior and/or superior cantholysis, orbital decompression, or simple puncture of the air vessel which may prevent the patient from blindness [ 11 , 12 , 15 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Posttraumatic Orbital Emphysema: A Numerical Model

Skorek

Kl̵osowski

Plichta

et al. 2014

Journal of Ophthalmology

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Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture) of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features—thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall). The observation was made from 1 · 10−3 to 1 · 10−2 second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Posttraumatic Orbital Emphysema: A Numerical Model

Skorek

Kl̵osowski

Plichta

et al. 2014

Journal of Ophthalmology

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“…Needle decompression should be undertaken with caution due to the risks of retrobulbar hemorrhage, scleral perforation, and optic nerve damage 3. Two cases of orbital emphysema mimicking inferior rectus entrapment in adults have been reported recently where the collection of air splinted the superior rectus muscle 8. We present the first description of this condition in a pediatric patient.…”

mentioning

confidence: 86%

“…3 Two cases of orbital emphysema mimicking inferior rectus entrapment in adults have been reported recently where the collection of air splinted the superior rectus muscle. 8 We present the first description of this condition in a pediatric patient.…”

mentioning

confidence: 98%

Medial Wall Fracture and Orbital Emphysema Mimicking Inferior Rectus Entrapment in a Child

Collin

Afshar

Thomas

2015

Craniomaxillofacial Trauma & Reconstruction

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Orbital emphysema is commonly associated with fractures of the orbital floor or medial wall. The air often dissipates spontaneously, but rarely can cause increased intraocular pressure and even loss of vision. Entrapment of the extraocular muscles can also occur with orbital fractures and may require prompt treatment in the pediatric patient due to the risk muscle ischemia. Both conditions can cause diplopia due to restriction of eye movement and differentiation of the two etiologies is important to prevent unnecessary surgical exploration. Identification and prompt management of raised intraocular pressure is essential in patients with orbital trauma. We present a case of orbital emphysema mimicking inferior rectus entrapment following trauma in an 11-year-old boy.

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