BLOW OUT FRACTURE.pptx

blow out fracture, oculoplasty

1. BLOW OUT FRACTURE Dr. Somy Purohit

2. Type of fracture- isolated comminuted which walls get affected- orbital floor medial wall type of trauma- indirect

3. buckling theory - blunt trauma hits the inferior rim of the orbit the floor of orbit folds fracture hydraulic theory- blunt trauma hits the circumference of the orbit intraorbital pressure increases thinnest wall breaks floor or medial wall

4. buckling theory

5. hydraulic theory

6. Fig.- a,c pure blowout fracture, b,d impure blow out fracture

7. clinical features periorbital edema ecchymosis emphysema parasthesia, anasthesia epistaxis proptosis enophthalmos and mechanical ptosis diplopia intraocular damage

8. periorbital edema it occus almost immediately and can mask other signs

9. ecchymosis

10. emphysema crepitus subcutaneous presence of air from paranasal sinus happens more in medial wall fracture can compress optic nerve and endanger vision

11. parasthesia, anasthesia area of infra orbital nerve cutaneous supply face, lower lid, cheek, side of nose upper lip and upper teeth

12. epistaxis ipsilateral early sign bleeding from maxillary sinus

13. proptosis variable initially due to hemorrhage and edema.

14. enophthalmos and mechanical ptosis backward and down ward movement of eye ball 3 reasons orbital fat sinks to maxillary sinus entrapment of inferior rectus causes backward traction due to displacement of bone fragments , enlargement of bony cavity. happens 10 days after edema reduses.

15. diplopia vertical diplopia- both in up and down gaze due to inferior rectus entrapment positive forced duction test

16. intraocular damage check for intra ocular damage

17. WHITE EYE FRACTURE children greenstick fracture flexible bone- small crack- trap door effect- entrapment of content of eye ball eye is quite symptoms- diplopia needs urgent attention

18. investigations plain X ray- waters view Ct scan MRI

19. plain x ray

20. ct scan

21. MRI

22. Management general measure surgical intervention

23. genral measures avoid blowing nose- may case mre herniation of orbital content into maxillary antrum systemic antibiotics analgesis and anti inflammatory cold compress- vaso constriction

24. surgical repair immediate repair- white eye # globe luxation into maxillary antrum after 2 weeks(edema subsides) unresolving diplopia a fracture with large herniation into antrum >50% in ct scan enophthalmos mre than 3mm large fracture that may cause enophthalmos ct evidence of muscle entrapment

25. wait and observe good clinical motility minimal diplopia clinical improvement in 1-2 week absence of enophthalmos no Ct evidence of entrapment small bony defect that dose not cause enophthalmos

26. implants autologous bone graft autologous cartilage graft silicone titanium porous polyethylene

27. approach for surgery transcutaneous transconjunctival

28. thank you