Fracture of orbit (orbit of eye): danger, operation, consequences

Orbit of the eye is an anatomical fossa on the skull. Most often, the fractures are combined, that is, they are found in combination with the trauma of other bones of the facial part of the skull, such as, for example, the frontal, temporal, malar, maxillary or osseous parts of the root tissue and the back of the nose, the walls of the orbit itself.

Description of injury

Trauma of this zone is very dangerous, because the fractures of any of the constituent walls of the orbit are almost always accompanied by concussion of the brain.

In addition to the combined fracture,rarely found (about 16.1% of all cases) isolated fracture of the orbit, which is, as a rule, the result of a direct impact towards the eyeball. And more often the impact is from the side of the lower or inner wall, that is, those walls that limit the paranasal sinuses from the cavity of the orbit. Hence the name of the "explosive" trauma.

Subcutaneous emphysema is the accumulation of air inthe result of a traumatic "exposure" and the ingress of gas from the cavity of the orbit into the adjacent paranasal sinuses. This phenomenon is most often detected after a strong exhalation through the nose, after which the air, trapped in the subcutaneous formations, as it were, "crunches" when pressed onto the periorbital region.

Often there is a pinching of the lower rectus muscle, especially with a fracture of the bottom of the orbit, so there is a restriction of the eye movement upward, and it causes the development of diplopia (double vision in the eyes).

In addition, there may be a hemorrhage in the muscles or surrounding tissues with a restriction of mobility already down.

Major symptoms of orbital fracture

This affliction is manifested by the following symptoms:

• presence of severe swelling around the injured eye, possible development of subcutaneous emphysema;
• spreading the process and to nearby areaswith the involvement of the root and the back of the nose, the upper part of the buccal region, the upper and lower eyelids, and also the lesion of the gums and teeth of the predominantly upper jaw;
• violation of innervation of these areas, leading to a decrease in sensitivity to various types of stimuli;
• the patient can not make the eyeball move upwards due to damage to the lower rectus muscle of the eye;
• phenomena of diplopia (bifurcation of objects) due to hemorrhage and edema in the region between the lower oblique and straight muscles on the one hand and the periosteum on the other;
• not so rarely observed and enofthalm, the eyeball in this case as it were pressed into the interior of the orbit;
• sounds of crepitus due to the development of subcutaneous emphysema.

Diagnostics

Diagnosis of orbital fracture:

• determination of the degree and volume of mobility of the outer muscle group of the eyeball;
• conducting an external examination to identify the chemosis (edema of the conjunctiva with the involvement of the eyelid) and swelling of the soft tissues;
• definition of crepitations in the palpation of areas of the zone with the development of subcutaneous emphysema and displacement of bone fragments (if any);
• application of methods of neurological examination for the purpose of revealing hypoesthesia (decrease of sensitivity to various kinds of stimuli) along the infraorbital nerve;
• definition and measurement of proptosis (loss of the eyeball) and enophthalmia (occlusion);
• ophthalmologic biomicroscopic method of studying subconjunctival hemorrhages, chemosis and other criteria of traumatic injury.

Additional diagnostics

A significant part of the victims are foundsigns of proptosis and prose, as a result of traumatic hemorrhage in the tissue and muscle and swelling in the facial part of the skull. When examined, it is possible to identify foreign bodies of different sizes and structures. Approximately 30% of all "explosive" fracture of the orbit combined with the development of erosions of the cornea, phenomena traumatic hyphema (signs of hemorrhage into the anterior chamber), iritis (inflammation of the iris), the gap eyeball signs shake retina, its detachment and finally hemorrhage.

The severity of the orbital fracture is high.

It is preferable to perform computed tomography (CT), and for better understanding of the state of the orbital walls, it is desirable to perform axial and coronal thin sections.

To identify the fracture and the introduction of orbital content in a number of located sinuses, it is necessary to examine the inner (medial) part of the bottom and the wall adjacent to the nasal bone.

Inspection of the bony vertex allows us to reveal the state of the posterior margin of the bone, which is performed without fail during the operation.

The main manifestations depend on the strength of the attachedimpact of the facial part of the skull and accompanying lesions: thus, with a fracture of the predominantly upper wall, the percentage of development of brain concussion is high. With a fracture of the lower or inner (medial) wall, spreading of mucosal secretions through lesions to the paranasal sinuses with concomitant infection is possible.

How to treat a fracture of the orbit? Let's consider further.

Principles of therapy

The aim of the treatment is to preserve eitherrestoration of the structure of the eye socket and its contents, that is, the eyeball (recovery of the volume of movement of both active and passive muscles, elimination of such unpleasant accompanying symptoms as diplopia or, for example, strabismus, which gives the victim considerable discomfort).

Often in this situation, they resort to operationalinterference, which at the same time has an adverse effect on the contents of the orbit, which manifests itself in the form of excessive pressure on the eyeball. The danger is also that the hemorrhage that occurs behind the eye several times increases the pressure exerted on the optic nerve, and mainly on its disc, which entails not only a deterioration of vision, but also an unfavorable outcome and a complete loss of it.

Since a trauma involves a lot of otherthe anatomical components of the skull, therefore, the load on these affected parts, in particular, the pressure exerted on the respiratory tract, is also forbidden. A simple effort, even insignificant, such as blowing, leads to an increase in pressure inside the zygomatic arch, which aggravates the edema and can provoke a complete eye closure, or contribute to the development of subcutaneous emphysema.

Indications for surgical intervention

Let's consider in what cases the operation is shown:

• diplopia, or in other words, double vision in the eyes, inthe direction of the gaze downwards (at an angle of 30 degrees from the primary one) or directly, provided that pathological changes are preserved for more than two weeks after trauma with a simultaneous radiological confirmed fracture and a positive response to the traction test;
• enofthalm, exceeding 2 millimeters;
• fracture of the bottom of the orbit, which is more than half of its total area, dangerous in view of the possibility of the rapid development of late hypo- and enophthalmos;
• omission of the contents of the orbit and the value of enofthalm more than 3 millimeters with simultaneously confirmed excess of the volume of the orbit cavity by 20% or more.

Types of operations of the orbital fracture

According to the timing of the operation, earlysurgical intervention performed in the acute period of the trauma within the first two weeks, that is, exactly at the time when there are the most optimal conditions for restoring integrity and ensuring adequate physiological functioning of the affected organ. Also, the operation can be delayed, performed after a two-week period, but before the fourth month after the injury. This is the so-called "gray period". And, finally, the later provision of medical care, requiring mandatory osteotomy.

The most effective methods of treatment includesurgical, 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 carried out from the sideone of the walls of the orbit may include providing enhanced access to the opening of the fracture area and the consequent possibility of applying different types of prostheses.

Consequences of orbital fracture

Fracture of the orbit is a serious trauma. Assistance must be provided in a timely manner. Otherwise, dangerous, extremely undesirable complications and consequences can arise. The visual function is disturbed, it threatens with an absolute and irreversible loss of vision.

The most common consequences are developmentstrabismus, diplopia. Possible concussion, pain shock, concomitant injuries. It is not excluded complications of an infectious nature. The absence of treatment leads to the formation of fibrous, bone intergrowths.

Thanks to the achievements of modern medicine, the above undesirable consequences are prevented, and the visual function of the victim is also completely restored.