The orbit of the eye is an anatomical pit in the skull. Most often, fractures are combined, that is, they are found in combination with trauma to other bones of the facial part of the skull, such as, for example, the frontal, temporal, zygomatic, maxillary or bone part of the tissue of the root and back of the nose, the walls of the orbit itself.
Description of injury
Injury to this area is very dangerous, because fractures of any of the constituent walls of the orbit are almost always accompanied by concussion.
In addition to the combined fracture, a rare (about 16.1% of all cases) isolated orbital fracture is also distinguished, which is usually the result of a direct blow towards the eyeball. Moreover, more often the blow occurs from the side of the lower or inner wall, that is, precisely those walls that limit the paranasal sinuses from the cavity of the orbit. Hence the name "explosive" injury.
Subcutaneous emphysema - accumulation of air as a result of traumatic "exposure" and gas from the cavity of the orbitinto adjacent paranasal sinuses. This phenomenon is most often detected after a strong exhalation through the nose, after which the air that has entered the subcutaneous formations, as it were, "crunches" when pressed on the periorbital area.
It is not uncommon for the inferior rectus muscle to become pinched, especially when the orbital floor is fractured, so there is limited upward movement of the eye and causes diplopia (double vision).
Besides this, bleeding into the muscles or surrounding tissues is possible with limitation of mobility already down.
Main symptoms of a fractured orbit
This ailment is manifested by the following symptoms:
- presence of severe swelling around the injured eye, possible development of subcutaneous emphysema;
- spread of the process to nearby areas involving the root and back of the nose, the upper part of the buccal region, the upper and lower eyelids, with damage to the gums and teeth, mainly in the upper jaw;
- violation of the innervation of these areas, resulting in a decrease in sensitivity to various types of stimuli;
- the patient cannot move the eyeball upward due to damage to the lower rectus muscle of the eye;
- phenomena of diplopia (bifurcation of objects) due to hemorrhage and edema in the area between the lower oblique and rectus muscles on one side and the periosteum on the other;
- enophthalmos is not so rarely observed, the eyeball in this case is, as it were, pressed into the orbit;
- sounds of crepitus due to developmentsubcutaneous emphysema.
Diagnosis
Diagnosis of a fractured orbit:
- determination of the degree and volume of mobility of the outer muscle group of the eyeball;
- performing an external examination to detect chemosis (edema of the conjunctiva involving the eyelid) and soft tissue swelling;
- determination of crepitus during palpation of areas of the zone with developed subcutaneous emphysema and displacement of bone fragments (if any);
- application of neurological examination methods to detect hypoesthesia (decrease in sensitivity to various types of stimuli) along the infraorbital nerve;
- determination and measurement of proptosis (prolapse of the eyeball) and enophthalmos (retraction);
- ophthalmic biomicroscopic method for the study of subconjunctival hemorrhages, chemosis and other criteria of traumatic injury.
Additional diagnostics
A significant part of the victims show signs of proptosis and prose, as a result of traumatic hemorrhage in the tissue and muscles and swelling in the facial region of the skull. On examination, foreign bodies of various sizes and structures can be detected. Approximately 30% of all "explosive" orbital fractures are combined with the development of corneal erosion, traumatic hyphema (signs of hemorrhage in the anterior chamber), iritis (inflammation of the iris), rupture of the eyeball, signs of retinal concussion, its detachment, and, finally, hemorrhages.
Severityorbital fracture high.
Computed tomography (CT) is preferred, and axial and coronal thin sections are desirable for a better idea of the state of the walls of the orbit.
To detect a fracture and introduce the contents of the orbit into adjacent sinuses, it is necessary to examine the inner (medial) part of the bottom and the wall adjacent to the nasal bone.
Examination of the bone vertex allows you to identify the condition of the posterior edge of the bone, which is mandatory during surgery.
The main manifestations depend on the strength of the applied blow to the facial part of the skull and associated injuries: for example, with a fracture of the predominantly upper wall, the percentage of brain concussion is high. In case of a fracture of the lower or inner (medial) wall, mucous membrane secretions may spread through the lesions into the paranasal sinuses with concomitant infection.
How to treat a fractured eye socket? Consider further.
Principles of Therapy
The goal of treatment is aimed at maintaining or restoring the structure of the orbit and its contents, that is, the eyeball (restoring the range of motion of both active and passive muscles, eliminating such unpleasant accompanying symptoms as diplopia or, for example, strabismus, which give the victim a significant discomfort).
Often in this situation, they resort to surgical intervention, which has at the same time andan adverse effect on the contents of the orbit, manifested in the form of excessive pressure on the eyeball. The danger also lies in the fact that the hemorrhage that occurred behind the eye several times increases the pressure exerted on the optic nerve, and mainly on its disc, which entails not only a deterioration in vision, but also in an unfavorable outcome and its complete loss.
Since the trauma also involves a lot of other anatomical components of the skull, therefore, the load on these affected parts is also prohibited, in particular, the pressure exerted on the airways. A simple effort, even a slight one, for example, when blowing your nose, leads to an increase in pressure inside the cavity of the zygomatic arch, which exacerbates swelling and can provoke a complete closure of the eye, or contribute to the development of subcutaneous emphysema.
Indications for surgery
Let's consider the cases in which the operation is shown:
- diplopia, or in other words, double vision, in the direction of gaze down (at an angle of 30 degrees from the primary) or straight, provided that these pathological changes persist for more than two weeks after the injury, with simultaneous radiologically confirmed fracture and the presence of a positive reaction for the traction test;
- enophthalmos greater than 2 millimeters;
- fracture of the bottom of the orbit, accounting for more than half of its total area, dangerous in view of the possibility of early development of late hypo- and enophthalmos;
- omission of eye socket contents andthe value of enophthalmos is more than 3 millimeters with a simultaneously confirmed excess of the volume of the orbital cavity by 20% or more.
Types of orbital fracture operations
According to the timing of the operation, early surgical intervention is performed, performed in the acute period of injury, within the first two weeks, that is, exactly in the period of time when there are the most optimal conditions for restoring the integrity and ensuring adequate physiological functioning of the affected organ. Also, the operation can be delayed, performed after a two-week period, but up to the fourth month after the injury. This is the so-called "grey period". And finally, late medical care, requiring mandatory osteotomy.
The most effective methods of treatment include surgery, in which there are several methods for correcting the bone tissue of the orbit and zygomatic arch. All of them are similar in that they are made through small incisions, which then heal, that is, they become completely invisible.
This operation can be performed from one of the walls of the orbit, may include providing extended access to the opening of the fracture area and the subsequent possibility of using various types of prostheses.
Consequences of a broken eye socket
Fractured orbit is a severe injury. Help must be provided in a timely manner. Otherwise, dangerous, highly undesirable complications and consequences may occur. visual functionviolated, it threatens with absolute and irreversible loss of vision.
The most common consequences are the development of strabismus, diplopia. Possible concussion, pain shock, concomitant injuries. Complications of an infectious nature are not excluded. Lack of treatment leads to the formation of fibrous, bone growths.
Thanks to the achievements of modern medicine, the above undesirable consequences are prevented, and the visual function of the victim is also fully restored.
