Orbital Trauma and Surgery

Question 1

Basic description of Le Fort I, II, and III fractures?

Answer 1

I: low transverse maxillary fracture without orbital involvement
II: pyramidal configuration involving nasal, lacrimal, and maxillary bones extending to medial orbital floor
III: complete craniofacial disjunction

Question 2

Three types of N-O-E (naso-orbital-ethmoidal) fractures?

Answer 2

I: central bone fragment still attached to canthal tendon
II: comminuted fracture of central fragment
III: comminuted tendon attachment or avulsed tendon

Question 3

Depressed bridge of nose and traumatic telecanthus after face striking solid surface?

Answer 3

N-O-E (naso-orbital-ethmoidal) fracture

Question 4

Three main indications for surgery for orbital floor fractures?

Answer 4

1. enophthalmos > 2 mm
2. large fracture >50% of floor (especially if extending to medial wall)
3. diplopia with limitation of gaze within 30 degrees of primary gaze and positive forced duction test after resolution of edema

Question 5

Management of child with periorbital ecchymosis and restriction of elevation at site of blunt trauma?

Answer 5

CT to evaluate for fracture and entrapment; if inferior rectus entrapped through “trap door” fracture, urgent surgery is indicated for pediatric population

Question 6

Time frame for surgical repair of orbital floor fractures in adults?

Answer 6

within 2 weeks of initial trauma

Question 7

Initial management of intraorbital BB pellet?

Answer 7

CT or MRI (MRI is safe for BBs) and observation

Question 8

True or false regarding management of traumatic optic neuropathy:

1. high-dose steroids have been shown to provide visual benefit over observation alone
2. orbital decompression has been shown to provide visual benefit over observation alone

Answer 8

1. false

2. false

Question 9

Name and describe the five surgical spaces of the orbit

Answer 9

subperiosteal (between periorbita and bone)
extraconal (between periorbita and muscle cone), intraconal (within muscle cone)
subarachnoid (between optic nerve and nerve sheath), sub-Tenon (between Tenon capsule and globe))

Question 10

Structures to be careful to avoid during transcaruncular incision?

Answer 10

lacrimal canaliculi and lacrimal sac

Question 11

Severe orbital pain postoperatively?

Answer 11

orbital hemorrhage

Question 12

Hypoesthesia of the cheek and maxillary teeth?

Answer 12

damage to infraorbital nerve

Question 13

What structure is at risk for damage in lateral approaches to the intraconal space?

Answer 13

ciliary ganglion

Question 14

hit in side of face with bat, exam shows hypoglobus and lateral displacement: locations of fractures?

Answer 14

ZMC fracture: frontozygomatic suture, inferior orbital rim, zygomatic arch, and lateral wall of the maxillary sinus

Question 15

proposed mechanism of vision loss in orbital compartment syndrome

Answer 15

occlusion of posterior ciliary arteries (lower perfusion pressure than CRA)