blow out fractur

8/12/2019 Blow Out Fractur

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BLOW OUT FRACTUR

DEDY IRAWAN



DEFINISI

Blowout fractures are caused by directtrauma to the globe which causes anincrease in intraorbital pressure and

decompression via fracture of theorbital floor.



PATOFISIOLOGI

• Blow-out fracture may result in cases of abrupttrauma to the eye by any object >5cm in diameter.Because the orbital rim is very strong, the forces ofblunt trauma are reflected back, compressing theeye and creating a tremendous increase in pressure

within the orbit.• Since the larger bones which comprise the orbit

contain sinuses, the orbital walls are at great riskfor fracture; should the trauma be of sufficientforce, these walls can literally "blow out." The

medial wall (ethmoid bone) is occasionally affected.But most commonly, the orbital floor (the superioraspect of the maxillary bone) sustains the damage.In cases of floor fractures, the eye may partiallydrop down into the maxillary sinus, causingenophthalmos and entrapment of the inferior rectus

or inferior oblique muscle.



• This entrapment leads to a tethering effect, resulting ina limited downgaze ability and, more notably, aninability toward upgaze in the affected eye. While thissituation can be surgically corrected in the early stages,prolonged entrapment leads to fibrosis of the muscle(s)

and permanent motility impairment. Associated medialwall fractures may induce damage to the medial rectusmuscle and/or the lacrimal apparatus, but this isuncommon.

• In most cases, these fractures result in orbitalemphysema, creating a direct communication betweenthe ethmoid sinus and the orbit. This produces thefeeling of pressure within the orbit when the patientattempts to blow his/her nose. The greatest risk toconsider with medial wall fractures is orbital cellulitis,secondary to sinus infection, should pathogenic

organisms within the sinus invade the post-tarsal eyelid



SYMPTOM

• Pain ( terutama saat gerak matavertikal )

• Local tendernes

• Double vision

• Edema palpebra

•

Crepitus after nose blowing• Riwayat trauma



SIGN

CRITICAL SIGN

• Pergerakan bola mata terbatas

• Subcutan or conjungtiva emphysema

• Hipestesia N. infraorbitalis

• Point tendernes

•

enoftalmus



OTHERS

• Nose bleeding

• Edema & echymosis palpebra

• Hipestesia N. supraorbitalis

• Trismus

•

Malar flatening• Palpable stepoff deformity tripod

fracture



DIFFERENTIAL DIAGNOSA

• Edema orbita dan perdarahan tanpablow out fracture

• Cranial nerve palasy



PLANNING DIAGNOSA

• Pemeriksaan mata

• Forced duction test

• Foto waters

• CT scan orbita



TREATMENT

• Nasal decongestan

• Antibiotik broad spectrum

• Instruction the patient not to blow hernose

• Kompres es pada orbita

•

Surgical repair



Surgical repair

• Immediate repair

• If there is evidence on CT scan ofentrapped muscle or periorbital tissue in

combination with diplopia & non resolvingbradycardia, heart block, nausea, vomitus,syncope

• In patient < 16 th, with a quiet external

periocullar appearance and markedmotility retriction

• Repair in 1-2 week

blow out fractur

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