Orbital Wall Fractures: Evaluation and Management

Abstract

Over a 49-month period, 121 orbital wall fractures were treated and 92 were followed for a median of 6.5 months (minimum, 3 months). Associated injuries included a 17% incidence of serious globe or optic nerve injuries and 13% incidence of lacrimal drainage disruption. Diplopia occurred in 23% and dystopia in 11%. Management was by observation alone in 14% and exploration in the remainder, with layered gelfilm for defects smaller than 4 cm2, alloplastic sheeting for defects to 6 cm2, and outer cortex of parietal bone for larger dehiscences. There were no decrements in vision from operation, dystopias were corrected to within 2 mm of normal, and diplopia persisted only in those with extraocular muscle paresis. There was no benefit to exploration of orbital wall defects smaller than 2.5 cm2 or with reduction of other midfacial fractures (e.g., malar) when neither dystopia nor entrapment was present, because defects not obturated in such cases had no sequelae.

Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: Anatomical and surgical aspects

“…The roof of the orbit was least frequently involved (n:9). Floor fractures usually occur as secondary injuries from maxilla and zygomatic bone trauma (Osguthorpe, 1991;Sollmann et al, 1989). In this study, we found that, in 112 of the cases (19.05%), the orbital fracture occurred secondary to maxillary trauma.…”

“…Common posttraumatic orbital injuries include anterior chamber injuries, injuries to the lens, open-globe injuries, ocular detachments, intra-orbital foreign bodies, carotid cavernous fistula, and optic nerve injuries (Kubal, 2008;Turvey, 1977). In the past, isolated orbital fractures, which may have complications such as diplopia, enophtalmia, exophtalmia, extraocular muscle weakness, pupillary shape dysfunctions, optic globe injury or perforation, retinal detachment and vision dysfunction have been widely studied by different authors (Fulcher and Sullivan, 2003;Osguthorpe, 1991;Read and Sires, 1998;Straker and Hill, 1989). Orbital emphysema is a recognized complication of fractures of the orbit and rarely poses a threat to vision.…”

“…In our study, we operated on 4 of 10 cases with optic nerve injuries. After blunt trauma of orbit, the rate of complications in the optic globe and adnexial injuries (globe perforation, orbital cranial nerve lesions, enophthalmos, exophthalmos) were found to be between 2.7% and 18% (Ioannides et al, 1988;Luce et al, 1979;Osguthorpe, 1991). Oculomotor, trochlear and abducens nerve injuries can occur as a result of ethmoid and sphenoid bone fractures (Miller, 1985;Rose et al, 1992).…”

Etiologia e incidência das fraturas faciais em adultos e crianças: experiência em 513 casos

“…In this situation the fracture may be difficult to see due to overlapping of anatomical structures (orbit wall and temporal bone) 12,23 . According to Busuito et al (1986) and Sherer et al (1989) these failures in diagnosis do not occur with other facial fractures (mandibular and maxillary fractures), mostly caused by motor vehicle accidents and physical violence.…”

The Success Rate of Endocanalicular Laser Dacryocystorhinostomy with Two Different Mitomycin-C Application

“…Basically, it is a bypass surgery in which obliterated nasolacrimal duct is bypassed and lacrimal sac is opened directly into the nasal cav- ity. Traditionally this operation is done via an external approach with high success rates (82-99%) [4][5][6][7][8][9][10][11]. In spite of such good results, the procedure has various disadvantages like eksternal skin incision and scar, excessive intra-operative bleeding, disruption of the medial canthus anatomy, long surgical time and high morbidity [12].…”