BLOW OUT FRACTUR

DEDY IRAWAN
DEFINISI
Blowout fractures are caused by direct
trauma to the globe which causes an
increase in intraorbital pressure and
decompression via fracture of the
orbital floor.

PATOFISIOLOGI
Blow-out fracture may result in cases of abrupt
trauma to the eye by any object >5cm in diameter.
Because the orbital rim is very strong, the forces of
blunt trauma are reflected back, compressing the
eye 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 risk
for fracture; should the trauma be of sufficient
force, these walls can literally "blow out." The
medial wall (ethmoid bone) is occasionally affected.
But most commonly, the orbital floor (the superior
aspect of the maxillary bone) sustains the damage.
In cases of floor fractures, the eye may partially
drop down into the maxillary sinus, causing
enophthalmos and entrapment of the inferior rectus
or inferior oblique muscle.
This entrapment leads to a tethering effect, resulting in
a limited downgaze ability and, more notably, an
inability toward upgaze in the affected eye. While this
situation can be surgically corrected in the early stages,
prolonged entrapment leads to fibrosis of the muscle(s)
and permanent motility impairment. Associated medial
wall fractures may induce damage to the medial rectus
muscle and/or the lacrimal apparatus, but this is
uncommon.
In most cases, these fractures result in orbital
emphysema, creating a direct communication between
the ethmoid sinus and the orbit. This produces the
feeling of pressure within the orbit when the patient
attempts to blow his/her nose. The greatest risk to
consider 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 mata
vertikal )
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 tanpa
blow 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 her
nose
Kompres es pada orbita
Surgical repair

Surgical repair
Immediate repair
If there is evidence on CT scan of
entrapped muscle or periorbital tissue in
combination with diplopia & non resolving
bradycardia, heart block, nausea, vomitus,
syncope
In patient < 16 th, with a quiet external
periocullar appearance and marked
motility retriction
Repair in 1-2 week