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This is a second case of a patient who was punched in the eye.

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As we scroll the coronal images, we note the defect

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in the orbital floor on the left side.

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There are a couple of important findings to report

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when one sees an orbital floor fracture. On the normal side,

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we see the location of the infraorbital foramen.

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We've previously seen a case of perineural spread along the

0:29

infraorbital nerve, where I described the infraorbital foramen.

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On the left side, the affected side,

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we see that the infraorbital foramen is involved

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by the fracture, with small fracture fragments that

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are disrupting the infraorbital foramen.

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This is important to note for the reconstruction of the orbital

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floor and to explain the potential for long-term paresthesia or

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hypoesthesia of the face along the sensory

0:59

distribution of the infraorbital nerve.

1:01

If we look at the soft tissue windows, we also see herniation of

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tissue through the fracture into the maxillary antrum roof.

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And we note that the density of this tissue includes some low

1:16

density tissue, as well as intermediate-density tissue.

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Let's scroll through the coronal images.

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What we see is the tenting of the inferior rectus muscle through

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the fracture site with a component of orbital fat

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herniating through the fracture site, as well.

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Once again,

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this is entrapment of the inferior rectus

1:44

muscle and the orbital fat.

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Sometimes, even with just orbital fat herniation,

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you will have restriction of motion of the

1:55

affected globe, leading to diplopia.

1:59

Certainly, when one has muscular entrapment through the fracture

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site, you're more likely to have diplopia.

2:06

So these findings of fat herniation, muscular herniation,

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and involvement of the infraorbital nerve canal,

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are findings that should be reported with respect

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to orbital floor fractures.

2:20

By the same token,

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we would look for involvement of the medial rectus muscle

2:27

were we to have lamina papyracea fractures

2:31

of the medial orbital wall.

2:34

Once again,

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a potential pitfall is calling the defect in the superior

2:41

posterior portion of the medial orbital wall, a fracture when it

2:47

represents an opening of either the anterior

2:50

or posterior ethmoid artery.

2:54

Here, we can see the posterior ethmoid artery opening,

3:01

which could simulate a fracture.

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In general,

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with orbital floor fractures,

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we expect to see blood products in the maxillary

3:11

antrum or some fluid.

3:14

If we have a fracture without blood products or soft tissue

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swelling, or fluid in the maxillary antrum, and we see a fracture,

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it could be that this is an old fracture and

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clinical evaluation would be required.