Medial orbital wall fracture

Intra-/periorbital air is a common finding of an orbital wall fracture, which appears clinically as emphysema (independent of whether the injury was penetrating or nonpenetrating). This is due to the fact that the fracture will communicate with the sino-nasal cavities.

Clinical diagnosis is based on a meticulous examination of the eye, including the patient’s vision and palpation of the orbital rims.

Since the advent of CT imaging, the surgeon can better define fractures, the degree of fracture displacement, and the necessity for fracture reduction. CTs should be obtained in the axial and coronal planes and sagittal views such as those obtained in the longitudinal axis of the optic nerve.

The complexity of an orbital fracture is defined by the combination of its anterior-posterior and mediolateral extensions. This complexity is not visible on plain films. Therefore, proper diagnosis and treatment should be based on voxel-based datasets (CT, cone beam).

The most widely available technology is CT scanning, which has the advantage of combined hard- and soft-tissue visualization. Cone beam technology is becoming increasingly popular, although only hard tissues can be reliably assessed. MRI is limited to soft-tissue visualization and provides only indirect information on hard tissues. It is rarely obtained for specialized evaluation of orbital soft tissue.

In some cases, it is difficult to appreciate the fracture's full extent, morphology, and quality from the CT scan alone. In very complex cases, a complete understanding of the fracture is obtained only after surgical exposure.

Coronal slices (hard-tissue window) of an isolated left medial orbital fracture.

Axial slices (hard-tissue window) of an isolated left medial orbital fracture.