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ARTICLES
Year : 1982  |  Volume : 30  |  Issue : 5  |  Page : 499-500

Management of orbital fractures


Department of Ophthalmology & Radiology Narinder Mohan Hospital, Mohan Nagar, Ghaziabad, India

Correspondence Address:
Subhash Goswamy
Department of Ophthalmology, Narendra Mohan Hospital Gaziabad
India
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Source of Support: None, Conflict of Interest: None


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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

How to cite this URL:
Goswamy S, Jang N, Jain P K, Satyanath S. Management of orbital fractures. Indian J Ophthalmol [serial online] 1982 [cited 2020 Nov 26];30:499-500. Available from: https://www.ijo.in/text.asp?1982/30/5/499/29241

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 Top


The cases presented with facial and head in­juries examined in our hospital, both clinically and_radiological by were analysed here.


  Observations and discussion Top


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.




 

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