Medial Wall Fractures Research Articles

Fractures of the medial orbital wall

Two cases of patients with isolated medial orbital wall fractures are described. Presenting physical findings were minimal; however, both patients were noted to have bleeding into the nasopharynx from unidentified sources. Routine radiographs failed to disclose the fractures, which were clearly shown by computed tomography. Reconstructive surgery was planned for one patient. Frequently overlooked, this injury may be the cause of delayed enophthalmos, meningitis, or blindness. The presentation, diagnosis, and management of medial orbital wall fractures are reviewed.

Medial orbital wall fracture with enophthalmos

An isolated blow-out fracture of the medial orbital wall is uncommon, whereas the incidence in conjunction with an orbital floor fracture is high. The most striking features of an isolated medial wall fracture are diplopia on medial and lateral gaze and/or enophthalmos. The cases of two patients with a fracture of the medial orbital wall with enophthalmos are presented. One patient had an isolated medial wall fracture, whereas the other had a combined medial and inferior orbital wall fracture. Treatment of the enophthalmos consisted of exposure of the medial wall fracture site using a bicoronal flap, freeing of the herniated soft tissues and reconstruction of the defect with an autogenous medial iliac bone graft. The incidence, aetiology, pathogenesis, signs and symptoms and surgical treatment of the isolated orbital medial blow-out fracture are discussed.

Surgical Repair of Medial Wall Fractures

We treated ten patients with medial wall fractures, five of whom had concomitant floor fractures. The most consistent preoperative findings were restriction in abduction with retraction of the globe and limitation in adduction. A direct medial canthal surgical approach provided adequate exposure for removing incarcerated tissue as well as covering the defect with a thin silicone implant. There were no surgical complications or evidence of implant migration, the longest follow-up being two years. Of the ten patients, six had satisfactory results with full or nearly full ductions, one was orthophoric in the primary position but still had significant restriction in abduction, and three had persistent diplopia in the primary position.

Computerized Tomography and B-Scan Ultrasonography in the Diagnosis of Fractures of the Medical Orbital Wall

Ultrasound and CT scans have been used to examine 12 patients with suspected medial orbital wall fractures. A good correlation between ultrasound and CT scanning was demonstrated, and the authors believe that either investigation is a suitable alternative to conventional radiology when this type of injury is suspected.

Orbital Blowout Fractures: An Approach to Management

Cadaver studies and clinical evidence are presented to suggest that medial wall fractures are often concomitant with orbital floor fractures. The medial wall fractures are located in the ethmoid bone midway between the medial canthus and the lesser wing of the sphenoid. These fractures may be the etiology of late enophthalmus. The discrepancy between the high frequency of occurrence of medial wall fractures in this study and the rarity of clinical diagnosis derives from the limitations of standard radiography. Computed tomography (CT scan) is useful in delineating these fractures. The operative approach is through an incision above the medial canthus. Surgical treatment includes reduction of the herniated periorbital fat and coverage of the defect with autogenous, homologous, or alloplastic materials.

A technique for reconstruction of blow-out fractures of the medial orbial wall (case report)

Summary A case of enophthalmos with blow-out fracture of the medial orbital wall and of the floor of the orbit in a 15-year-old boy is presented. Only very few authors have published an operative procedure for this lesion. Reconstruction of the medial orbital wall fracture was achieved by inserting a preformed allograft into the ethmoidal space after clearing out the ethmoidal cells via an antral approach. The procedure, advantages and possible dangers are discussed.

Concomitant Medical Wall Fracture and Blowout Fracture of the Orbit

Medial wall fractures of the orbit should be considered a frequent component of the entity termed blowout fracture. Fracture of the medial wall without fracture of the floor did not occur in this series. Hypocycloidal tomography affords the best radiologic technique for diagnosing orbital fractures.

The retraction syndrome and trauma.

A case of traumatic medial wall fracture of the orbit with incarceration of orbital contents is presented. There was associated retraction of the globe and narrowing of the palpebral fissure on attempted abduction. The unusual nature of these two signs is discussed.