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Treatment Planning & Seminar

Karam Bassam 200910300

Amrou Mohamed 200910538

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The Case

Gender : Male Age : 32

PMH: Healthy

Patient is presented with BLOW to cheek

C/F: 1.Bruises

2.Blurred Vision

3. Diplopia

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Differential Diagnosis

Possible causes of diplopia due to trauma

include:

Zygomatic Complex Fracture

Blowout Injury/Orbital Floor Fracture

1. Orbital contusion with associated edema,

hemorrhage, and muscle contusion2. Orbital fracture with/without entrapment

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Zygomatic Complex fracture

Associated

Ocular Complications :

1-Retinal detachment.2-Dislocation of the lens.

3-Injuries to the globe.

4-Orbital floor fractures.

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Orbital floor Fracture

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Overview:

Strong TRAUMA

PAIN and BLOWOUTof orbital floor

1- BRUSIS.

2- DIPLOPIA.

3- EDEMA of EYELID.4- ENOPHTHALMOUS.

5- EPISTAXIS.

6- NAUSEA.

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Clinical examination

Ocular examination for vision acuity.

Palpation of the orbit for creptius.

External examinationfor edema.

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Investigations

Radiographs to confirm the diagnosis :

1. MRIfor examining the optic nerve

2. CT scan for the facial bones3. Occipitomental view

4. Submentovertex view for the zygomatic arch

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Final Diagnosis

Zygomatic complex fracture

Reasons:

1. Blow to the cheek2. Ophthalmic nerve

3. Infraorbital nerve and artery

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Treatment Plan

Aims

1-To correct diplopia and restore normal vision

2-To restore orbital volume when walls and floorare fractured

3-To restore the normal contour of the face for

cosmetic reasons.

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Treatment of diplopia

Includes observation and surgical repair

Timing of surgery: As soon as initial edema or

hematoma subsides (5-7 days)

Considerations: presence or absence of

entrapment, prescence of

diplopia,enophtalmous

Transconjuctival approach preferred.

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Treatment of possible zygomatic

fracture

Treatment objective: To place fragments in

normal position and to fix them during the

course of healing

Same period of time before the start of

surgery

Open reduction and intraosseous wire fixation

indicated.