Most common wall involved in blow out fracture of orbit is
Correct Answer: Inferior
Description: (D) Inferior[?]Non-penetrating injury:A blow in the orbital region without the penetration of a foreign body may lead to an intraorbital haemorrhage; this may occur from pressure with forceps at birth.Forward dislocation of the globe between the lids occurs most often when the blow is directed from the outer side where the orbital margin affords least protection, but does not necessarily result in loss of sight.Blow-out fractures of the orbit are usually due to blunt trauma caused by a large object such as a cricket ball.The object transmits force into the orbit, which is then reflected back.As the orbital opening is blocked by the object the force is directed at the orbital walls, damaging the thinner walls that abut the sinuses.Most commonly the orbital floor 'blows out', but it can also affect the medial wall of the orbit.As the orbital floor fractures, the eye and its surrounding tissues may collapse into the maxillary sinus, causing enophthalmos and entrapment of the inferior rectus muscle.The patient may present with pain, local tenderness, epistaxis and diplopia.The patient may complain of a prominence of the eye on blowing his nose.On examination there is an initial oedema, ecchymosis or emphysema around the ocular adnexa with a restriction of ocular movements, commonly upwards or outwards.Associated damage to the sinuses may cause orbital crepitus. Infraorbital hypoesthesia may be present because of an entrapment of the infraorbital nerve.CT scan should be done.Wound should not be probed without expert guidance, dusted antibiotic powder and a prophylactic course ofSystemic antibiotic treatment.If suppuration occurs, the foreign body must be removed and the case treated as one of orbital cellulitis.Orbital Blow-Out Fracture:Most common orbital injury.Typical history of a blow by blunt, may be rounded object (>5cm in size)Fracture of the inferior medial orbitClassical triad of:Diplopia (restrictive strabismus)Infraorbital numbness (Interruption of infraorbital nerve)Periocular ecchymosis (Skin & Muscle damage)Theories of Blow-Out Fracture:Direct Injury (Retropulsion):Sudden compression of globe with orbital floor fracture (increased orbital & ocular pressure).Indirect injury (Bucking):Blow to inferior rim causes a ripple effect causing fracture.Blowout Fracture of the Orbit:Fractures of the orbital floor may occur with orbital wall fractures or as an isolated injury.When the orbital floor, being the weakest area, herniation of orbital contents down into the maxillary sinus may occur (hanging drop sign).Patients may present with enophthalmos, impaired ocular motility, diplopia due to entrapment of the inferior rectus muscle within the fracture fragments, and infraorbital hypoesthesia.Whenever a solid object of around 5 cm impacts on the orbital area, there is a dramatic rise of orbital pressure that to which the thinnest long wall of orbit gives way, and usually it is the inferior orbital wall.Some times the muscle or tendon of inferior rectus and inferior oblique may get entrapped in fracture line, causing elevate of eye ball difficult. There is also subcutaneous emphysema, due to the escape of air from maxillary antrum hypothesis and enophthalmos.
Category:
Ophthalmology
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