Lateral Orbital Wall Fractures Research Articles

Frontal basilar trauma: classification and treatment.

We report our experience with 14 consecutive cases of frontal basilar trauma occurring in children and adolescents aged 18 months to 18 years (mean 9.5 years). Brain parenchymal injury resulting in functional deficit occurred in 5 patients (36 percent), 2 patients suffered bilateral blindness, and 1 suffered unilateral loss of vision. A classification system and treatment algorithm based on the clinical fracture pattern seen by computed tomography are introduced. Type I, central, is confined to the upper nasoethmoidal complex, central frontal bone, and medial third of the superior orbital rims. Type II, unilateral, involves the entire supraorbital rim and the upper lateral orbital wall, extending into the squamosa of the temporal bone and ipsilateral frontal bone. Type III, bilateral, involves fractures of the upper nasal ethmoidal complex, bilateral supraorbital and upper lateral orbital wall fractures, and bilateral frontal bone fractures. This classification was utilized to plan elective orbital and cranial osteotomies, similar to those used for frontal orbital advancement at the time of acute fracture repair. Frontal orbital osteotomies were used to access the anterior cranial fossa, orbital apices, and nasofrontal ducts and to obtain an intact bony template for side-table reassembly of the fracture fragments. There was no significant operative morbidity, one late cerebrospinal fluid leak, and no infections. Reoperation was necessary in four patients (29 percent) for aesthetic indications.

Optic nerve decompression via the lateral facial approach

Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high-dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach with partial return of visual acuity and without surgical complications. The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post-traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.