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Question What is Blow-out Fractures of the Orbit

Dr. Adnan

Member
The usual mechanism is a blow to the eye...

The object transmits a force into the orbit which is reflected back, but due to the blocking of the orbital opening by the object, the force is transmitted to the walls of the orbit...

The most commonly involved is the Orbital Floor (the floor is usually the path of least resistance, and fractures downward into the maxillary sinus)

but occassionally medial wall can also be fractured...
As the floor fractures, eye and its surrounding tissues may collapse into the maxillary sinus...
This leads to the clinical sign Enopthalmos...
Patient may present with pain, tenderness, epistaxis, diplopia and also with the complaint of prominence of the eye on blowing his nose...
On a Waters view, one may see a soft tissue mass on the superior margin of the maxillary sinus, representing the herniated periorbital tissues into the sinus. One may also see a "trapdoor" fragment of bone protruding down into the sinus, often hinged on the ethmoidal side. CT will, of course, show these fractures and soft tissue mass much better. Computerized coronal tomography is also useful...
The diplopia can be corrected by insertion of thin layer of silicone rubber or teflon plate between periosteum and bone of the orbital floor after reducing the herniation of the eye-ball...
"blowout fracture" -- the arrows point to the fracture fragments and periorbital tissue which have herniated into the maxillary sinus

"blowout fracture" -- the arrows point to the fracture fragments and
periorbital tissue which have herniated into the maxillary sinus
 
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