Orbital Floor & Wall Fracture

ORBITAL FLOOR & WALL FRACTURE

Orbital floor and wall fracture is a common finding seen in car accident or trauma. When a blunt trauma hit onto the globe, the force will transmit and break the thinner and more fragile medial and floor below. Therefore it is also referred as orbital floor blow out fracture.  It can cause entrapment of muscle / sudden expansion of orbital space leading to disruption of eye muscle pulleys system and subsequently double vision.  The similar condition can also occur in children in which the inferior rectus muscle may be trapped (trapdoor orbital fracture).  If left unreleased, the muscle will become fibrotic and permanently lose its function and lead to permanent double vision. The child usually does not complain much except initially nausea and vomiting due to vagal reflexes secondary to trapped muscle.   The eye interestingly is quite white and the child may adapt to initial diplopia by suppressing vision from other eye causing diplopia symptom to disappear.   Therefore it is quite common this emergency condition is frequently overlooked and under-treated.    As mentioned earlier, if left untreated the double vision is usually present for life.

The sudden expansion of orbital space also causes eye to look sunken which will worsen with time. Sadly, they are commonly dismissed and lead to patients suffer intractable double vision and facial disfigurement.

TREATMENT

Studies showed early intervention yield better outcome and hence it is important to seek oculoplastic surgeons’ opinions early.  Orbital floor fracture surgery should be performed early although later reduction is possible but require volume advancement.   The procedure involves a small incision in lower eyelid or sometimes behind the eyelid (transconjunctival) to reduce the fracture and free up any entrapped soft tissue.  Sometimes an orbital implant may be required.   Currently, Dr. Ho Shu Fen also using intraoperative navigation (First in Perak) to enhance precision of the plate insertion .

Patient can be discharged home the same day after recovery from general anesthesia.  As the implant is made of titanium, there is no restriction for the future flying.

Pre op: After a near fatal accident, for many months post op he was diagnosed to have CN III palsy and assume the eye deviation will follow for life.

Pre op: After a near fatal accident, for many months post op he was diagnosed to have CN III palsy and assume the eye deviation will follow for life.

Post op: After replacing the floor , the eye no longer deviated out.

Post op: After replacing the floor , the eye no longer deviated out.

Pre op: Limitation in upgaze after a car accident

Pre op: Limitation in upgaze after a car accident

Post op: no more difficulty in looking up after orbital floor fracture repair.

Post op: no more difficulty in looking up after orbital floor fracture repair.

Pre op: impaired downgaze with orbital floor fracture

Pre op: impaired downgaze with orbital floor fracture

Post op: Improved downgaze after orbital floor fracture repair

Post op: Improved downgaze after orbital floor fracture repair

Pre Op: The left eye has sunken in secondary to volume expansion after a fracture in the floor of orbit.

Pre Op: The left eye has sunken in secondary to volume expansion after a fracture in the floor of orbit.

Post op: improved symmetry post orbital floor fracture repair

Post op: improved symmetry post orbital floor fracture repair

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