Orbital Floor Fracture

Fractures of the orbital floor and the medial orbital wall (blowout fractures) are common midface injuries.Orbital fractures have a distinct trauma mechanism and are complex, due to the complex anatomy of the bony and soft tissue structures involved.Knowledge of anatomy is mandatory when dealing with patients presenting with trauma to the orbit.The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bone. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze and tethering. Finally, the orbital injury can lead to retinal edema, hyphema and significant loss of vision.While some cases may be managed with conservative care, others may require some type of surgical intervention.