Daily Bolus of LR: Inferior Orbital Floor Fracture

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April 25, 2011 by dailybolusoflr

Inferior Orbital Floor Fractures

 

·         Typical mechanism of fracture involves direct force applied to the orbit by a structure that is greater than the diameter of the globe. 

·         Theories postulate the as the intra-orbital pressure increases, orbital bones break at their weakest point.

·         This is usually the medial orbital floor.

·         Complications commonly associated with this type of injury:

·         Entrapment

§  The orbital contents descend into the fracture site and/or into the maxillary sinus.

§  The inferior rectus muscle can become entrapped in the fracture site. This results in limited ability to look upwards. 

§  Patients may also c/o pain with attempts to look up or vertical diplopia. 

§  Note: Severe pain associated with limited horizontal and vertical movements can be indicative of more severe orbital hemorrhage and/or associated edema.

·         Enophthalmos

o    A large orbital floor fractures with significant prolapse of the orbital contents into the maxillary sinus can lead to the appearance of a sunken eye.  This may not be as apparent in the acute setting due to edema.  

·         Nerve

o    The infra-orbital groove provides the exit point for the infra-orbital nerve .  This runs along the inferior orbital floor.

o    Edema/trauma to the nerve can lead to decreased sensation of the cheek and upper gum.

o    This is usually temporary but can last be long lasting or permanent.

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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