April 25, 2011 by dailybolusoflr
Inferior Orbital Floor Fractures
· Typical mechanism of fracture involves direct force applied to the orbit by a structure that is greater than the diameter of the globe.
· Theories postulate the as the intra-orbital pressure increases, orbital bones break at their weakest point.
· This is usually the medial orbital floor.
· Complications commonly associated with this type of injury:
§ The orbital contents descend into the fracture site and/or into the maxillary sinus.
§ The inferior rectus muscle can become entrapped in the fracture site. This results in limited ability to look upwards.
§ Patients may also c/o pain with attempts to look up or vertical diplopia.
§ Note: Severe pain associated with limited horizontal and vertical movements can be indicative of more severe orbital hemorrhage and/or associated edema.
o A large orbital floor fractures with significant prolapse of the orbital contents into the maxillary sinus can lead to the appearance of a sunken eye. This may not be as apparent in the acute setting due to edema.
o The infra-orbital groove provides the exit point for the infra-orbital nerve . This runs along the inferior orbital floor.
o Edema/trauma to the nerve can lead to decreased sensation of the cheek and upper gum.
o This is usually temporary but can last be long lasting or permanent.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions