Blowout fracture-a case report (author's transl)

Abstract

The patient, a male aged 13, since he had been punched in the right eye by an elbow in playing judo, complained of enophthalmos of the right eye, diplopia, slight reduction of the vision and restriction of upward gaze. X-ray examination revealed the downward herniation of the tissues prolapsing in semicircular shape from the orbit into the right antrum and diagnosed as blowout fracture. Twenty-one days after the injury, Caldwell Luc's operation was performed under general anesthesia. The herniated tissues from the orbital floor in the right antrum were replaced by hand into the orbit using the anterior sinus wall for the implant. Following the surgery, the patient had no enophthalmmos, no diplopia, and no restriction of upward gaze, and vision was olso recovered.The blowout fractures results from a force applied directly to the orbit from in front without rupturing the eyeball, which the weakest portion of the orbital floor and lamina papyracea so that the soft tissues blow out into the ethmoid and the antrum because of the sudden increase in intraorbital pressure.The diagnostic conditions can be summarized as follows after Weiss:1. History of a recent blunt injury to the eye.2. Vertical extraocular muscle imbalance with diplopia.3. Radiographic demonstration of prolapse of the periorbita, often with fracture.4. Hypesthesia of the infraorbital nerve is oten present.5. A positive traction test of the inferior rectus muscle.Treatment mainly depends upon the surgical repair to reconstruct the orbital floor, replace the prolapsed tissues and free the trapped muscles. The followings are surgical approaches mainly adopted:(1) Maxillary sinus route (Caldwell Luc approach)(2) Infraorbital approach(3) A combination of (1) and (2)In recent years orbital fractures are increasing with rising number of automobile accidents. It is necessary for the otolaryngologist to grapple with the difficult problems positively.