Orbital fracture - Revision history

Rossdonaldson1: /* Evaluation */

2021-09-25T12:35:20Z

Evaluation

← Older revision		Revision as of 12:35, 25 September 2021
Line 46:		Line 46:

	==Evaluation==		==Evaluation==
	[[File:Orbitalblowout.png\|thumbnail\|Left orbital floor fracture on cT]]		[[File:Orbitalblowout.png\|thumbnail\|Left orbital floor fracture on CT]]
			[[File:PMC4786376 cureus-0008-000000000487-i01.png\|thumb\|Head CT image with maxillary sinus opacification on coronal (left) and sagittal (right) non-contrast head CT images. Example of a typical fracture involving the right orbital floor (green arrow) and medial maxillary sinus wall (red arrow), which is associated with resultant hemorrhage and an air-fluid level in the right maxillary sinus (blue star).]]
	*Obtain orbital CT as initial study if significant clinical findings		*Obtain orbital CT as initial study if significant clinical findings
	**Evidence of fracture on exam		**Evidence of fracture on exam

Rossdonaldson1: /* Clinical Features */

2019-08-16T02:27:09Z

Clinical Features

← Older revision		Revision as of 02:27, 16 August 2019
Line 16:		Line 16:
	==Clinical Features==		==Clinical Features==
	[[File:Infrectus.png\|thumbnail\|Inferior rectus highlighted in blue. Entrapment of muscle causes upward gaze diplopia.]]		[[File:Infrectus.png\|thumbnail\|Inferior rectus highlighted in blue. Entrapment of muscle causes upward gaze diplopia.]]
			[[File:PMC3375999 eplasty12ic09 fig1.png\|thumb\|Orbital fracture with right eye entrapment.]]
	===Orbital fracture===		===Orbital fracture===
	*Enophthalmos (globe herniation)		*Enophthalmos (globe herniation)

Kxl328: /* Management */

2018-10-17T04:43:47Z

Management

← Older revision		Revision as of 04:43, 17 October 2018
Line 58:		Line 58:

	==Management==		==Management==
	*Fractures of medial and inferior walls may be considered open fractures into sinus mucosa~~, and strong consideration should be made for antibiotics~~		*Fractures of medial and inferior walls may be considered open fractures into sinus mucosa
			**Cephalexin x5-7 days
			**OR amoxicillin-clavulanate x5-7 days
			**No difference between 5-7 days vs. 10-14 days of treatment<ref>Reiss B et al. Antibiotic Prophylaxis in Orbital Fractures. Open Ophthalmol J. 2017; 11: 11–16.</ref>
	*Isolated orbital fracture		*Isolated orbital fracture
	**[[Cephalexin]] 250-500mg PO QID x10d		**[[Cephalexin]] 250-500mg PO QID x10d

Kxl328: /* Management */

2018-10-17T04:40:50Z

Management

← Older revision		Revision as of 04:40, 17 October 2018
Line 58:		Line 58:

	==Management==		==Management==
			*Fractures of medial and inferior walls may be considered open fractures into sinus mucosa, and strong consideration should be made for antibiotics
	*Isolated orbital fracture		*Isolated orbital fracture
	**[[Cephalexin]] 250-500mg PO QID x10d		**[[Cephalexin]] 250-500mg PO QID x10d

Kxl328: /* Background */

2018-10-17T04:38:30Z

Background

← Older revision		Revision as of 04:38, 17 October 2018
Line 1:		Line 1:
	==Background==		==Background==
			*Thin inferior wall frequently injured, requires less energy
			*Medial wall consists of thin lamina papyracea, requires intermediate energy
			*Lateral blow out fractures require higher force
	===Types===		===Types===
	*Blow-out Fracture		*Blow-out Fracture

Rossdonaldson1: /* Clinical Features */

2018-02-27T14:03:16Z

Clinical Features

← Older revision		Revision as of 14:03, 27 February 2018
Line 13:		Line 13:
	==Clinical Features==		==Clinical Features==
	[[File:Infrectus.png\|thumbnail\|Inferior rectus highlighted in blue. Entrapment of muscle causes upward gaze diplopia.]]		[[File:Infrectus.png\|thumbnail\|Inferior rectus highlighted in blue. Entrapment of muscle causes upward gaze diplopia.]]
	*Findings suggestive of orbital fracture:		===Orbital fracture===
	**Enophthalmos (globe herniation)		*Enophthalmos (globe herniation)
	**Orbital rim step-off		*Orbital rim step-off
	**Crepitus		*Crepitus
	**Infraorbital anesthesia (damage to infraorbital nerve from orbital floor fracture)		*Infraorbital anesthesia (damage to infraorbital nerve from orbital floor fracture)
	**[[Diplopia]] on upward gaze		*[[Diplopia]] on upward gaze
	***Entrapment of inf rectus or inf oblique or orbital fat		**Entrapment of inf rectus or inf oblique or orbital fat
	***Injury to oculomotor nerve		**Injury to oculomotor nerve
	*Findings suggestive of naso-orbito-ethmoid fracture
	**Pain with eye movement		===Naso-orbito-ethmoid fracture===
	**Traumatic telecanthus		*Pain with eye movement
	**Epiphora (tears spilling over lower lid)		*Traumatic telecanthus
	**CSF leak		*Epiphora (tears spilling over lower lid)
	*Findings suggestive of ocular involvement:		*CSF leak
	**[[Retrobulbar hematoma]] or malignant orbital emphysema
	***Exophthalmos, decreasing visual acuity, increased ocular pressure		===Findings suggestive of ocular involvement===
	**[[Globe rupture]]		*[[Retrobulbar hematoma]] or malignant orbital emphysema
	***Extrusion of intraocular contents, severe conjunctival hemorrhage, a tear-shaped pupil		**Exophthalmos, decreasing visual acuity, increased ocular pressure
	**Orbital fissure syndrome		*[[Globe rupture]]
	***Fracture of orbit involving the sup. orbital fissure		**Extrusion of intraocular contents, severe conjunctival hemorrhage, a tear-shaped pupil
	****May result in injury to oculomotor and ophthalmic divisions of CN V		*Orbital fissure syndrome
	****Paralysis of extraocular motions, ptosis, periorbital anesthesia		**Fracture of orbit involving the sup. orbital fissure
			***May result in injury to oculomotor and ophthalmic divisions of CN V
			***Paralysis of extraocular motions, ptosis, periorbital anesthesia

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Disposition */

2018-02-27T14:01:31Z

Disposition

← Older revision		Revision as of 14:01, 27 February 2018
Line 69:		Line 69:

	==Disposition==		==Disposition==
	*Isolated orbital fracture		===Isolated orbital fracture===
	**Discharge with follow up in 3-10d		*Discharge with follow up in 3-10d
	**Refer to ophtho for outpatient full dilated exam to rule-out unidentified retinal tears		*Refer to ophtho for outpatient full dilated exam to rule-out unidentified retinal tears
	*Naso-orbito-ethmoid fracture
	**Admit		===Naso-orbito-ethmoid fracture===
			*Admit

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2018-02-27T14:00:39Z

Background

← Older revision		Revision as of 14:00, 27 February 2018
Line 1:		Line 1:
	==Background==		==Background==
	*Types		===Types===
	**Blow-out Fracture		*Blow-out Fracture
	***Fracture of inferior or medial orbital walls with out fracture of orbital ridge		**Fracture of inferior or medial orbital walls with out fracture of orbital ridge
	***Adipose tissue, ~~inf~~ rectus or ~~inf~~ oblique can entrap within maxillary or ethmoid sinus		**Adipose tissue, inferior rectus or inferior oblique can entrap within maxillary or ethmoid sinus
	***33% are associated with ocular trauma		**33% are associated with ocular trauma
	**Non Blow-out Fracture		*Non Blow-out Fracture
	***Lateral, ~~inf~~, and ~~sup~~ orbital ridge fracture typically occurs with other facial fractures		**Lateral, inferior, and superior orbital ridge fracture typically occurs with other facial fractures
	*Naso-orbito-ethmoid fracture		*Naso-orbito-ethmoid fracture
	**Associated with force applied to nasal bridge		**Associated with force applied to nasal bridge

DrKarb: /* Clinical Features */

2018-02-21T15:42:40Z

Clinical Features

← Older revision		Revision as of 15:42, 21 February 2018
Line 17:		Line 17:
	**Orbital rim step-off		**Orbital rim step-off
	**Crepitus		**Crepitus
	**Infraorbital anesthesia (orbital floor fracture)		**Infraorbital anesthesia (damage to infraorbital nerve from orbital floor fracture)
	**[[Diplopia]] on upward gaze		**[[Diplopia]] on upward gaze
	***Entrapment of inf rectus or inf oblique or orbital fat		***Entrapment of inf rectus or inf oblique or orbital fat

Aganapathy: /* Evaluation */

2018-01-22T00:47:18Z

Evaluation

← Older revision		Revision as of 00:47, 22 January 2018
Line 50:		Line 50:
	*Otherwise can obtain Waters' view first		*Otherwise can obtain Waters' view first
	**Shows cloudy maxillary sinus representing blood, fluid or tissue		**Shows cloudy maxillary sinus representing blood, fluid or tissue
			*Check for associated infraorbital nerve injury

	==Management==		==Management==