orbital floor fracture radiology
A evaluate the bony orbit for fractures note any herniations of orbital contents and pay particular attention to the orbital apex. Left orbital floor fracture.
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There is a right orbital floor blowout fracture entrapping the inferior rectus.
. There is marked architectural distortion of the globe. Blow-out fractures are so named because of the tendency for soft tissue to herniate out of the orbit. These are generally the result of high-energy trauma and are most commonly seen in association with other fractures 10 11A pure blow-in fracture is one limited to the orbital walls while the orbital rim remains intact Figs.
It involves the lens and orbital fat and is associated with a right maxillary sinus hemorrhage. B evaluate the anterior chamber. 113 Orbital floor blowout fracture.
3-D images can also facilitate a broader understanding of the fracture impact on facial width height and. This fracture can also affect the muscles and nerves around the eye keeping it. CT is the best modality for identifying an occipital condyle fracture 6.
As maxillofacial fractures are frequently concomitant with head trauma because of the close anatomical proximity of the facial skeleton to the cranium 12 orbital fractures account for a significant portion of facial trauma 345Furthermore among orbital fractures the orbital floor is the most commonly involved wall due to its thin bony. Orbital floor fractures OFF with entrapment require prompt clinical and radiographic recognition for timely surgical correction. These images demonstrate downward buckling of the inferior orbital wall involving the medial aspect of the infraorbital canal compatible with fracture.
Forty-four patients with final diagnosis of orbital floor fractures in the period 1990-94. Occipital condyle fractures are rarely evident by x-ray 56. Fractures are best visualized on coronal and sagittal reformatted images.
A blowout Fracture of the orbital floor is defined as a fracture of the orbital floor in which the inferior orbital rim is intact. Pfeiffer proposed the Globe-to-Wall Theory which is when a force pushes the globe into the orbit and causes the globe to contact the orbital floor resulting in a floor fracture. The aim of this study was to compare the efficacy of plain films and computed tomography CT in defining inferior orbital fractures and any muscle involvement.
Comminuted fracture - suggests impaction. The orbital rim is relatively strong so force is transmitted to the weakest parts of the orbit which blow-out. Orbital floor implant position is best assessed in the.
Orbital floor fracture This is when a blow or trauma to the orbital rim pushes the bones back causing the bones of the eye socket floor buckle to downward. Orbital fractures are common occurring in 10-25 of all cases of facial fracture 1. B Coronal bone image shows depressed right orbital floor fracture with orbital fat and retro-ocular gas herniating vertical arrow into the defectc Sagittal view demonstrates the anterior and posterior extent vertical arrows of the.
Orbital floor fractures can increase volume of the orbit with resultant hypoglobus and enophthalmos. Facial fractures can be identified by tracing the McGrigor-Campbell lines and Dolan lines. Correct CT radiographic interpretation of entrapped fractures can be subtle and thus missed.
The Waters view from the series is shown in Figure 1. The cause is sudden direct blunt trauma in the form of a blow to the orbit with increase in intraorbital pressure. Blowout Fracture of the Orbit.
The inferior orbital wall is most commonly affected by fracture 2. Aleft globe rupture B. The orbital MDCT is the imaging modality of choice for blow-out fracture diagnosis and evaluation for complications such as inferior rectus muscle entrapment.
C evaluate the position of the lens the lens may be displaced and it may be either completely or partially. It is estimated that about 10 of all facial fractures are isolated orbital wall fractures the majority of these being the orbital floor and that 30-40 of all facial fractures involve the orbit. Radiologists should evaluate facial fractures in multiple planes with coronal and sagittal reformats which are especially helpful for horizontally oriented facial fractures such as injuries to the orbital floor and the hard palate.
The size of the orbital floor fracture is often. The blow-in fracture is an inwardly displaced fracture of the orbital wall andor rim resulting in a reduced orbital volume. Question 2 You request a plain film series of the facial bones.
An orbital roof blow-out fracture may warrant a neurosurgery consultation for the risks of cerebrospinal fluid leak and brain injury. Hemorrhage partially fills the left maxillary sinus. Important aspects of evaluation include.
Radiology quiz Question 1 What is the most likely diagnosis. Left orbital floor fracture is depressed by 35 millimeters. When evaluating a patient with an orbital injury the radiologist should do the following.
Other secondary signs of facial fracture include opacification of adjacent air spaces which may fill with blood if a wall of that air space is fractured. Orbital floor which is the superior boundary of the maxillary sinus or. Left medial blowout fracture C.
10 A similar and more popular theory is the hydraulic mechanism whereby the fracture is the result of increased intra-orbital pressure from the eye. Contrary to popular belief the orbital floor is not horizontal in orientation but rather slopes upward toward its posterior aspect because of the conical shape of the orbit. Treatment Procedures at Our Hospital.
Gross tissue hemorrhage surrounds the right orbit with blood also within the partly collapsed right globe. Inferior orbital fractures can be caused by direct facial trauma. The inferior rectus muscle or orbital tissue can become entrapped within the fracture.
Approximating an identical slope at the time of repair of an orbital floor fracture is critical to restoring the premorbid orbital volume thus preventing enophthalmos. Etiology Fractures of the orbital floor are common. The indications for surgical repair of orbital fractures have been controversial.
A Axial computed tomographic view showing right globe proptosis and retro-ocular gas g. Common mechanisms include blunt trauma mainly from assault and motor vehicle accident. We reviewed the clinical radiographic and intraoperative findings of 45 cas.
Signs of orbital fracture typically include peri-ortbital bruising and subconjunctival hemorrhage. Left inferior orbital floor blowout fracture Dleft inferior orbital rim fracture. Fracture of the orbital floor can disrupt the.
No evidence of rectus muscle entrapment retrobulbar hemorrhage or proptosis. Bilateral frontal intraparenchymal hemorrhages. In each patient a CT scan with slices below 1 mm was performed meeting the guidelines and criteria set by the American College of RadiologyThe size of the orbital floor defect was measured using defect-delineating and orbital floor delineating tangents in the xVisionViewer software Vidis sro Prague Czech Republic.
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