|Year : 1982 | Volume
| Issue : 5 | Page : 499-500
Management of orbital fractures
Subhash Goswamy, Nita Jang, PK Jain, S Satyanath
Department of Ophthalmology & Radiology Narinder Mohan Hospital, Mohan Nagar, Ghaziabad, India
Department of Ophthalmology, Narendra Mohan Hospital Gaziabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goswamy S, Jang N, Jain P K, Satyanath S. Management of orbital fractures. Indian J Ophthalmol 1982;30:499-500
Isolated orbital fractures, though reported to be rare except the blow out fractures, are not so uncommon as observed by us in the last two years (1978 & 1979). Varied types of trauma is responsible for such injuries like fall from a height, jerk in moving train, violent blow with sticks etc., or automobile accidents. Majority of earlier reports regarding orbital fractures have been related to war injuries, where extensive facial injuries are noted.
Management of our cases required the timehonoured surgical principle of expectant treatment with close observations for a timely intervention in the deserving cases, so as to prevent any permanent damage to nerves and muscles and to recover full ocular, lacrimal and lid functions besides minimising the cosmetic blemishes.
| Materials and methods|| |
The cases presented with facial and head injuries examined in our hospital, both clinically and_radiological by were analysed here.
| Observations and discussion|| |
A resume of clinical presentation and their management has depicted that out of these 12 cases, first 6 cases were seen by us in the first 6 months and the rest in the remaining 18 months of study period (interestingly in the year 1980 also, that is after writing the present series of 12 cases, we have seen another 4 cases, all of which required only conservative management. The majority of cases (10) were received within 24 hours of the injury. Of the remaining 2 cases, one was seen after 3 days the other after 3 months. The nature of injuries were as follows :- Traffic accidents - 5, fall from a height- 3, other blunt injury 4. All except one were males. Except for 3 children, all were adult males. (18-45 years).
In this series we observed that in somecases it is only the fracture of orbital margins with some extension into the adjacent wall. Roof of the orbit was fractured in 7 out of 12 cases. Blowout fracture was seen in 2 cases and only one of them required operation, and for the second it was worth waiting. We undertook open reduction with suturing of fracture edges by steel wires (No. 30) in 5 out of 12
cases. Four of these cases were operated within 5 days. One was operated after 3 months. It is noteworthy that each case of over riding or displacement did not require open reduction, this was only done when no cosmetic or functional loss was expected during period of expectant observations.
The gravity of damage depended upon the violence of trauma rather than age or sex. When the trauma was of a smaller degree there may be only a crack fracture in the orbital margins without displacement. There was no break in skin, no oozing of blood, cerebrospinal fluid or brain matter, particularly so in adults.
Under close observation and with a patient conservative management, many cases improved without surgical intervention besides giving good functional and cosmetic results. Antibiotics were administered only when wound communicated directly with fracture site or surgical intervention was undertaken.
In children, on the other hand, where bones are delicate and where the gap between the outer and inner tables of the frontal bones is narrow, the fracture usually involves contents of the cranial cavity with the resultant leakage and prolapse of CSF, meninges and/or brain mater. These cases required early surgical intervention of the fractured bones (which were mostly multiple in nature). We observed that besides internal fixation of fractured pieces with stainless steel wires, it was useful to cover the gap with pericranium and periorbita and give additional support with plaster of paris over the sutured skin wound.
In all our cases which required surgical intervention for reduction of orbital fracture, it was most rewarding to approach the fracture sites under the periostium and free all the incarcerated orbital or intracraninal contents and keep them away while tightening the wires in an effort to approximate the fracture edge of the area concerned.
In the roof of the orbit fractures, a particular care was taken to prevent any damage to the pulley of the superior oblique muscle or lacrimal gland. In the case of fracture of the floor of the orbit, special care was taken to avoid damage to the inferior orbital canal and the lacrimal drainage system.
Demonstration of the fracture on the radiograph needs not only multiple views but also special care in positioning the patient and angulating the tube. Routine views for orbit like Skull AP and lateral, Orbital P.A. and lateral views may not suffice to diagnose all the cases. Skull P.N.S. view, hyperextended
P.N.S. view, oblique view of the orbit, views for the optic foramina, basal view of skull, tangential views may also have to be taken after clinical assessment of the individual case for the site of fracture. Even after many views fracture may be seen in only one particular view in a given case.
Our experience in managing these cases of orbital fractures has been that given an adequate conservative management, and selection of the right time for an early surgical intervention when needed, based on close observation of progress of clinical signs such as reduction of swelling and improvement in movements, and ptosis or enophthalmos of eye ball, one can prevent or minimize loss of adenexal functions and obtain the best of the cosmetic results possible depending upon the type and extent of trauma involved.