orbital wall fractures: Diagnosis and management

1. Orbital Wall Fractures: Diagnosis and
Management
By
Ayman Abd El-Ghaffar, MD
Assistant Professor of Ophthalmology
Mansoura Ophthalmic Center
Mansoura University

2. Pure orbital fracture

3. Causes
Blunt trauma e.g. motor car accident, a
fist, a ball.

4. Pathophysiology
1. Increase of intraorbital Pressure and secondary
floor fracture (direct) .
2. Impact to the orbital rim with momentary
Indentation (indirect) .

5. Axial CT Coronal CT

6. Types of orbital wall fracture:
1. Orbital floor fracture ± medial wall (blow out)
2. Roof fracture (blow in)
3. Lateral wall fracture
Zygomatio-orbital fractures, the most frequent, in 61%
Fractures of the orbital floor in 26%
Fractures of the medial wall in 9%
Fractures of the lateral wall in 3%
Fractures of the orbital roof in 1%

7. C/P
1. Ecchymosis of the lids
2. Emphysema
3. Infraorbital anaesthesia
4. Diplopia in up and downgaze
5. Enophthalmos

9. Investigations
Coronal CT with thin cuts (2-3 mm)

10. Total floor descend

11. Trapedoor fracture

12. Indications of surgery
1. Enophthalmos >2mm
2. Diplopia.
3. Fracture >1/ 3 floor

13. Time
Within two weeks

14. Technique
1. Lower fornix or transcutaneous approach
2. Incision of periosteum 2mm below the rim
3. Exposure of the floor & reposition of
prolapsed tissues
4. Application of the explant
5. Closure in layers.

15. Type of implants
1. Autologeous: bone graft, auricular cartilage.
2. Alloplastic: titanium mesh, prolene implant,
PPE implant and resorbable implants.

17. Goal

18. Post operative
Pre-operative
Case 1

19. Case 2
Pre-operative Post operative

20. Post operative
Pre-operative
Case 3

21. Case 4
Pre-operative Post operative

22. Case 5
Pre-operative Post operative

23. Roof fracture
. Uncommon when compared with other wall fractures.
. Usually associated with vigorous facial trauma.
. May be associated with ocular displacement.
. Orbital implants from the orbital side is difficult.
. surgical intervention often requires a team approach.

24. Lateral wall fracture
. Injury patterns may be isolated to the orbit or form part of a much
larger zygomatic-maxillary complex (ZMC) or pan-facial fracture
patterns.

25. Message
1. Early diagnosis of orbital floor fracture is extremly
valuable.
2. Repair of floor or medial wall fracture after resolution of
orbital oedema & hematoma maximum within 2 weeks.
3. A team work with ENT and neurosurgery is essential
especially in roof and lateral wall fracture.

26. Thank You