Medial orbital wall fracture_Is medial orbital wall fracture serious

When playing basketball or accidentally falling off a bicycle, you may hit your eyes. If you experience eye movement disorders, enophthalmos, nosebleeds and other symptoms, it is very likely that there is a fracture on the inside of the eye socket. You must go to the hospital for treatment, try to avoid affecting your vision, and undergo surgical treatment if necessary.

Symptoms and Signs

1. Diplopia and eye movement disorders

The characteristic manifestations of medial wall fractures are horizontal diplopia and eye abduction movement disorders. When the inner wall is fractured, the medial rectus sheath and soft tissue are embedded in the fracture gap, or the medial rectus muscle is displaced inward and adhered, restricting eye movement and causing diplopia.

2. Enophthalmos

Since most of the inner wall of the orbit is weak, fractures mostly form fracture fragments, and rarely linear cracks. As the fracture fragments are displaced, the volume of the orbital cavity increases, which is equivalent to the effect of orbital wall decompression surgery. This is the main reason for early onset of enophthalmos. For enophthalmos that occurs in the late stage after injury, orbital fat atrophy is the main cause.

3. Cerebrospinal fluid leakage

When the horizontal plate of the ethmoid bone is damaged above the fracture, cerebrospinal fluid leakage may occur.

4. Nosebleed

In case of post-injury nose bleeding, regardless of the presence of orbital emphysema, one must be alert to fractures of the inner wall of the orbit. Because the ethmoid sinus opening is low, bleeding is easy to drain.

Is a medial orbital wall fracture serious?

The severity of the injury depends on the extent of the fracture.

【Treatment method】

1. Conservative treatment

For patients whose CT scan clearly shows no extraocular muscle incarceration and whose orbital soft tissue herniation into the maxillary sinus is minimal, non-surgical treatment can be used. It is believed that diplopia at this time is the result of edema and inflammatory reaction, and a larger dose of glucocorticoids should be given to relieve the edema and inflammatory reaction caused by contusion and reduce adhesion formation. The use of hemostatic agents and vitamins can reduce tissue bleeding and promote the recovery of temporary motor nerve paralysis caused by contusion. Dehydrating agents may also be given to reduce interstitial edema. Functional training or repeated stretching should be performed while taking medication. A considerable number of cases can recover through the above treatment. .

2. Surgery

The purpose of surgery is to eliminate diplopia and correct enophthalmos as much as possible. Surgery may be considered if the following symptoms are present

①Ocular movement is obviously impaired, and the range of diplopia is large.

② The eyeball is obviously sunken, affecting the appearance.

②The traction test was positive, with no recovery trend.

④CT confirmed extraocular muscle incarceration and extensive orbital herniation.

2. Surgical approach

The most common incision for anterior repair surgery is a nasal skin incision. After the incision, separate towards the orbital rim, cut the periosteum from the orbital rim, and separate along the periosteum towards the deep orbital layer to expose the fracture of the inner wall of the orbit, free the extraocular muscles and soft tissues embedded in the fracture area, and reposition them. The orbital wall is repaired and enophthalmos is corrected at the same time, by filling the subperiosteum with autologous tissue or artificial synthetic materials, such as hydroxyapatite bone chips. When filling, make sure the implant is larger than the bone hole and placed under the periosteum. The filler can also shift the eye upward and forward. Improve enophthalmos and make it normal.