Presentation
Status post assault. Swelling to the right eye and nose. Tender to palpation.
Patient Data
There is a fracture of the right orbital roof superomedially with intracranial displacement of the fracture fragment. This fracture fragment demonstrates a trapdoor configuration with superomedial displacement. There is also herniation of orbital fat intracranially into the right anterior cranial fossa. The right superior rectus and levator palpebra are displaced toward the fracture site, consistent with tethering. There is associated hemorrhage within the superior extraconal right orbit.
There are comminuted bilateral nasal bone fractures with some fracture is of the adjacent frontal processes of the maxilla. These result in slight leftward displacement of the nasal arch. There is overlying nasal soft tissue swelling.
There is an obliquely oriented fracture involving the anterior medial aspect of the left maxillary sinus wall involving the anterior superior alveolar nerve. The fracture line extends through the left nasal lacrimal duct and extends into the frontal process of the maxilla. A nondisplaced fracture component posterior superiorly extends into the left lamina papyracea.
Case Discussion
This is a case of a superior orbital blowout fracture.
The patient was seen by otolaryngology and ophthalmology in the emergency department who noted that no emergent surgery was needed. The patient's visual acuity was intact. Outpatient follow-up appointments were scheduled.
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