Computed tomography of blow-out fracture of the medial orbital wall

Zilkha, Albert

doi:10.2214/ajr.137.5.963

Cited by 17 publications

(7 citation statements)

References 4 publications

(5 reference statements)

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“…112: , 2003 Blowout fractures of the medial orbital wall are not as rare as previously reported 1-6 since the introduction of computed tomography. [7][8][9][10][11][12] The incidence of medial wall fractures has been between 30.3 percent 13 and 69.2 percent 14 in cadaver studies, and between 42.8 percent 15 and 81.7 percent 16 in clinical studies.…”

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confidence: 99%

Endoscopic Endonasal Reduction for Blowout Fracture of the Medial Orbital Wall

Sanno

Tahara

Nomura

et al. 2003

Plastic and Reconstructive Surgery

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Endoscopic endonasal reductions have been addressed in 63 patients with blowout fracture of the medial orbital wall since 1992. The operations were carried out under general anesthesia with a magnified operative space projected on a television monitor by a charge coupled device video camera attached to the endoscope. The middle nasal turbinate was fractured toward the nasal septum, the uncinate process was cut off, and the bulla was opened. The ethmoidal bony partition and the mucous membrane were removed; however, the fractured bone chips of the medial orbital wall were preserved. The herniated orbital contents were pressed back into the orbital cavity, and the medial wall was set with 2-mm-thick bent silicone plates placed in the ethmoidal sinus. The plates were removed in the outpatient clinic 2 months after the operation. The surgical results of 21 patients treated with endoscopic reduction were compared with those of four patients treated with transfacial reduction with an iliac bone graft. All of the patients had isolated medial wall fracture and became aware of diplopia within 15 degrees in any direction from the primary position (straight gaze) before the operation; the follow-up period covered 6 months. The patients were classified into two categories according to postoperative double vision: "good," indicating no double vision or diplopia of more than 45 degrees, and "poor," diplopia of less than 45 degrees. Improvement of diplopia was observed in all patients without any complication. Of the 21 patients who underwent endoscopic reductions, 17 were classified as "good" and four as "poor." On the other hand, of the four patients who underwent transfacial reductions, three were classified as "good" and one as "poor." Significant differences were not observed between the surgical results of our two methods. Endoscopic endonasal reduction showed greater aesthetic advantages and, moreover, required no grafting. This technique is suggested as one of the most reasonable treatments of medial orbital wall fractures.

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Endoscopic Endonasal Reduction for Blowout Fracture of the Medial Orbital Wall

Sanno

Tahara

Nomura

et al. 2003

Plastic and Reconstructive Surgery

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“…2 ) or in combination with other facial fractures (approximately 50% of cases it is associated with the medial wall fracture). It is often characterized by bone fragments displaced into the maxillary sinus [ 17 ] (Figs. 2 , 3 ).…”

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confidence: 99%

Computed tomography in traumatic orbital emergencies: a pictorial essay—imaging findings, tips, and report flowchart

et al. 2022

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Computed tomography (CT) is considered the gold standard technique for the assessment of trauma patients with suspected involvement of the eye and orbit. These traumas can result in dramatic consequences to visual function, ocular motility, and aesthetics. CT is a quick and widely available imaging modality, which provides a detailed evaluation of the orbital bony and soft tissue structures, an accurate assessment of the globes, and is used to guide the patients’ treatment planning. For a timely and accurate diagnosis, radiologists should be aware of fracture patterns and possible associated complications, ocular detachments and hemorrhages, and different appearances of intraorbital foreign bodies. This educational review aims to describe all post-traumatic orbital abnormalities that can be identified on CT, providing a list of tips and a diagnostic flowchart to help radiologists deal with this complex condition.

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“…The advent of computed tomography (CT) in recent years has greatly revolutionized the diagnosis of medial orbital wall fractures with precise localization of the thin bone fragments, softtissue components of the orbit, and adjacent structures. 1,2,13,16 Clinical features of the medial wall fractures include periorbital edema and ecchymosis, subcutaneous emphysema from escape of air released from the ethmoid spaces into the eyelids, epistaßs, limitation of adduction, restriction of abduction, globe retraction (upon attempted abduction), and enophthalmos. 2, », 6,12,17,18 Pear118 suggests that enophthatmos may be worse from medial orbital wall blowout fractures than from blowout fractures of other walls.…”

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confidence: 99%

“…Fractures of the medial orbital wall may be missed by routine plain x rays because the compact overlapping anatomy of the orbit often conceals a clear view of the medial orbital wall 5,6,12 . Thus plain x‐ray films can be suggestive but are often not diagnostic 13 , 14 . In the experience of Fueger et al, 15 routine views detect fewer than 50% of surgically proven fractures.…”

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confidence: 99%

Medial orbital wall fractures: Classification and clinical profile

Nolasco

Mathog

1995

Otolaryngol.--head neck surg.

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This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory.

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Computed tomography of blow-out fracture of the medial orbital wall

Cited by 17 publications

References 4 publications

Endoscopic Endonasal Reduction for Blowout Fracture of the Medial Orbital Wall

Endoscopic Endonasal Reduction for Blowout Fracture of the Medial Orbital Wall

Computed tomography in traumatic orbital emergencies: a pictorial essay—imaging findings, tips, and report flowchart

Medial orbital wall fractures: Classification and clinical profile

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