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My Le Shaw, Jason A. Sokol, Jeremy Clark, Peter Timoney, H. B. Harold Lee, William R. Nunery; Diagnostic Usefulness of Computed Tomography Imaging in Orbital Floor and Medial Wall Fractures. Invest. Ophthalmol. Vis. Sci. 2011;52(14):726.
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To contrast and compare radiologic and clinical indications for surgical management of orbital floor and medial wall fractures in adult and pediatric populations.
Retrospective review of patients who underwent orbital floor or medial wall fracture repair by a single surgeon at the University of Louisville over 6 months. Consideration was given to mechanism of trauma, time to reconstruction, and clinical and radiological indications for surgery.
7 cases (5 male, 2 female) of orbital fracture with entrapment undiagnosed on CT were identified. All had clinically significant restriction of motility and diplopia. There were 3 medial wall and 6 floor fractures. The most common mechanism was sports related injury. The average age in the pediatric group was 7 and the single adult was 24. Range of time to repair was < 24 hours to 7 days. All radiology reports stated that there was no evidence of entrapment on CT and the muscle recorded as having normal shape. In 2 cases the report stated there was no fracture. In all cases, examination by the Orbit service demonstrated motility restriction leading to emergent repair, with surgical confirmation of entrapment. 1 patient with delayed repair resulting from missed entrapment had permanent injury to the muscle, with restriction in upgaze after 1 year. 6 cases of missed entrapment with surgical reconstruction had complete resolution of diplopia.
Small but clinically significant orbital fractures may be undiagnosed due to over reliance on imaging studies. While others have correlated round muscle shape with entrapment, we demonstrate that entrapped extraocular muscles may not have an altered appearance on CT. Clinical examination remains the gold standard for identifying entrapment in adults and children, leading to successful treatment of an entrapped fracture in which early repair is critical.
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