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Case 2 - Non-Ocular Orbital Trauma

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Well, I've done a lengthy segment on ocular imaging,

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and that's because I think that the individuals who

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are interpreting orbital CT scans in the trauma

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section are usually focused on fractures

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and not on the injury to the soft

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tissues, and in particular the injury to the anterior

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segment where you have anterior hyphemas and open

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globes and globe rupture of the anterior chamber.

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So, we've done a relatively lengthy section on that.

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Now, let's look at non-ocular orbital

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trauma. And in that situation,

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we really are focusing on fractures and

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one of the complications of fractures,

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which is entrapment.

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And then, we also will talk a little bit about

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retrobulbar hematoma and hematomas outside

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the muscle cone in the extraconal space.

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I want to use these diagrams to introduce the

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topic. So, when we're talking about fractures,

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sometimes those fractures can lead to entrapment,

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which leads to restriction of

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orbital or ocular motion.

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So you see in the bottom left image, someone

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who's been told to look upward

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outwardly and to the right side,

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and you notice that this globe is not moving.

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The left globe is turning,

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but the right is not moving.

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And that is what we're talking

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about by entrapment.

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And this is demonstrated in the diagram above,

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where we have the tendon has been trapped

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and is fixed at the site of the fracture.

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You see a small fracture here and there is no

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movement of this globe as it's not able to turn

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from right to left. It's kind of fixed in position.

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So that's what we're referring

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to with entrapment.

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With regard to the orbital floor fractures,

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which we're seeing here,

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the typical muscle that is herniating through the

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fracture segment is the inferior rectus muscle.

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And with the inferior rectus muscle,

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what happens is,

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as you can see on the involved eye,

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that the eye is not able to look up because the

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inferior rectus muscle is sort of fixed in position

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and not allowing that globe to rotate upward

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when you tell the person to look up.

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So obviously, the evaluation of entrapment is clinical.

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We can suggest that the person likely has

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entrapment when we see muscular or fat

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herniation through a fracture fragment.

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But remember that this is a

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clinical evaluation overall.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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