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Medial Wall Fractures

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Orbital Fractures

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Abstract

Medial orbital wall fractures are less common than blowout orbital floor fractures [1, 2]. Isolated medial wall fractures occur in only 4 % of cases [3, 4] and most commonly are a part of inferomedial or nasoorbitoethmoidal fractures [5–7]. While pediatric medial wall fractures are always isolated, in 1/3 of adult cases, they accompany other facial fractures [7], 50 % of which usually are nasal fractures [8].

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Notes

  1. 1.

    Esotropia, limitation of abduction, narrowing of palpebral fissure, pseudoptosis, and retraction enophthalmos (posterior displacement of the globe in abduction). The last symptom may be absent when medial rectus becomes entrapped in the posterior part of medial orbital wall (Fig. 4.2а).

  2. 2.

    Entrapment of the posterior part of medial rectus clinically manifests as a pseudoparalysis with intact lateral rectus (the anterior portion of the entrapped muscle fails to rotate the globe to the nose, while holding it in abduction). This uncommon syndrome can be falsely interpreted and delay surgical intervention (Fig. 4.2b–d).

  3. 3.

    One should remember that emphysema can also be the sign of pulmonary barotrauma [47], pneumomediastinum, tumor growth, or gas-producing microorganisms and even Munchausen syndrome.

  4. 4.

    The first descriptions of the pathogenesis of orbital emphysema were published by E. Fuchs (1901) and Ch. F. Heerfordt (1904).

  5. 5.

    It should be mentioned that such severe injury is uncommon. From 1900 to 1994 only 85 such cases were described [47].

  6. 6.

    Surgery in the first 4 days after injury guarantees complete regression of symptoms in 4–6 weeks. After delayed surgical treatment residual symptoms may persist for up to 10 months [4].

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Authors and Affiliations

  1. Department of Ophthalmology, Saint Petersburg State Hospital No. 2, Saint-Petersburg, Russia

    Vadim P. Nikolaenko MD, PhD, DSc

  2. Department of Otolaryngology and Ophthalmology, Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia

    Vadim P. Nikolaenko MD, PhD, DSc

  3. Department of Ophthalmology, I.P. Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia

    Yury S. Astakhov MD, PhD, DSc

  4. City Ophthalmologic Center at Saint Petersburg State Hospital No. 2, Saint-Petersburg, Russia

    Yury S. Astakhov MD, PhD, DSc

  5. ENT Department, First Pavlov State Medical University of Saint Petersburg, Saint-Petersburg, Russia

    Sergei A. Karpischenko

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  1. Ophthalmology, Saint-Petersburg State Hospital No. 2, Saint-Petersburg, Russia

    Vadim P. Nikolaenko

  2. Ophthalmology, I.P. Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia

    Yury S. Astakhov

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Nikolaenko, V.P., Astakhov, Y.S., Karpischenko, S.A. (2015). Medial Wall Fractures. In: Nikolaenko, V., Astakhov, Y. (eds) Orbital Fractures. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46208-9_4

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