0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

COMPLICATIONS

Meningitis is estimated to occur in 5–10% of patients. Rates are higher in
patients with CSF otorrhea or rhinorrhea.

Orbital Blowout Fracture

MECHANISM OFINJURY

■ Ball or fist pushes globe, and pressure from the globe fractures the orbital
floordown into maxillary sinus or through the lamina papyracea into the
ethmoid sinus.
■ Blunt trauma to orbital rim →buckle fracture of orbital floor—less likely
globe injury.

SYMPTOMS/EXAM

■ Swelling, ecchymosis, and tenderness of the periorbital region or infraor-
bital rim (see Figure 14.9)
■ Pain and diploplia may be present.
■ Numb cheek or upper lip (infraorbital nerve involvement)
■ Approximately 30% have associated ocular injury.
■ Assess for bleeding in ipsilateral nare.

DIAGNOSIS

■ Water’s view shows opacity in the roof of the maxillary sinus and air-fluid
level indicating fluid/blood in the affected sinus.
■ Facial CT (1–3 mm axial and coronal cuts) is more sensitive than Water’s
view (outdated).

TREATMENT

■ Ice to reduce swelling (may resolve entrapment)
■ ENT consult if entrapment present
■ Antibiotics
■ Te t a nu s
■ Ophthalmology consult to rule out ocular injury or if entrapment is suspected

Blowout fracture with

entrapment syndrome usually

involves the orbital floor with

entrapment of the inferior

rectus muscle.

FIGURE 14.9. Entrapment of the inferior rectus after an orbital blowout fracture of the
patient’s left eye.

(Reproduced, with permission, from Riordan-Eva P, Whitcher JP. Vaughan & Asbury’s General
Ophthalmology,16th ed. New York: McGraw-Hill, 2004:378.)