Orbital floor fracture
Introduction
Introduction to the sacral fracture Eyelid fractures can occur alone or in conjunction with other maxillofacial fractures, such as humeral fractures, frontal bone fractures, or maxillary LeFort II, type III fractures. Clinically encountered tibiofibular fractures include humeral fractures, superior temporal margin fractures, dome fractures, and internal and external wall fractures. The fractures of the sacral floor have certain characteristics in diagnosis and treatment. basic knowledge Probability ratio: the incidence of car accident injuries is about 0.5% Susceptible people: no specific population Mode of infection: non-infectious Complications: eyeballs
Cause
Cause of sacral fracture
The fracture of the sacral floor is weak, mainly composed of the maxillary condyle, that is, the upper wall of the maxillary sinus. The lateral part is the tremoric condyle. The bottom of the sac is a sloping plane extending upwards and backwards. The posterior part is a weak area with submental and axillary The crack passes through, and the area is connected with the sieving board to form the inner and lower walls of the bottom of the sputum. The thin inner layer is like a paper. When the middle part of the surface is broken by an external force, the bottom of the sputum impacts, causing a sharp increase in the internal pressure of the iliac crest. Fracture of orbital floor), this type of fracture is also called a blowout fracture. Because the underside of the sac is the maxillary sinus, the fracture of the sacral floor often causes the sputum to break into the upper sinus.
Prevention
Prevention of sacral fracture
The fracture of the lower eyelid is mostly caused by a falling or a large convex heavy object hitting the lower part of the eye or directly hitting the eyeball. The sudden increase in pressure causes the rupture of the weak wall. This patient falls on the corn root pile and is injured. In the left eye and the inferior wall, due to direct and indirect impact, the inferior wall of the inferior wall is invaded, and the eyeball and posterior ball are embedded in the maxillary sinus cavity. Due to eyeball crush injury, retinal blood supply disorder, optic nerve contusion, and increased eye tissue The edema and hypoxia make the visual function significantly impaired. In this case, the method of presenting the eyeball from the inside of the iliac crest is used. In this way, the time can be sought to minimize the damage caused by the retinal artery occlusion caused by the squeezing of the eyeball for a long time. The eyeball is invaginated and the silicon plate is placed in the sacral fracture. Therefore, the eye injury should be diagnosed as soon as possible. Try to consider all the factors that may occur after the trauma, and solve the damage caused to the eyeball as soon as possible to maximize the recovery of visual function. When the patient routinely took an X-ray of the eyelid, he found a fracture of the sacral floor, increased the density of the maxillary sinus cavity, and the patient's family sought unsuccessful eyeballs. Therefore, during surgery, pay special attention to the eyeball embedding. The possibility of the maxillary sinus cavity.
Complication
Complications of sacral fracture Complications
If the oculomotor nerve is damaged, it can also cause double vision. If there is more bleeding inside the sputum, the eyeball can be prominent and the eyeball can be trapped.
Symptom
Symptoms of sacral fractures Common symptoms Eyelid pain Eyeballs are prominent in the eyelids, ...
1. blood, swelling
Periorbital subconjunctival and subconjunctival hemorrhage can be used. If there is more bleeding inside the iliac crest, the eyeball can be prominent. The lower edge of the iliac crest can often reach the step and has tenderness.
2. Eyeballs are trapped
It is an important sign of the fracture of the sacral floor. The main causes of eye depression are: 1 due to the fracture of the sacral floor, the sputum content is displaced downward with the eyeball or into the maxillary sinus cavity; Increased, the amount of eyeball support for the eyeball is insufficient.
3. Double vision
In the case of a fissure fracture, the inguinal fossa includes the inferior rectus muscle, and the inferior oblique muscle and the fascia of the temporal wall are all displaced downward, so that the vertical movement of the extraocular muscle is restricted and diplopia occurs, such as the oculomotor nerve is damaged. Can cause double vision.
4. Underarm area numbness
The fracture piece of the sacral fracture often damages or compresses the infraorbital nerve, causing numbness in the innervation area.
Examine
Examination of the sacral fracture
Pull the test and clamp the inferior rectus muscle with tweezers.
X-ray examination: You can choose the Fahrenheit or the tomogram to observe the sacral cavity, the sacral floor and the maxillary sinus.
Diagnosis
Diagnosis and diagnosis of sacral fracture
History
A person with a blunt instrument larger than the eyelid that hits the eye or causes multiple fractures in the middle of the face should pay attention to the presence or absence of a sacral fracture.
2. Patients with mid-face fractures with eyeball depression and double vision.
3. The lower rectus muscle pull test is positive
After the anesthesia of the sacral anesthesia, the ophthalmology has a gingival sac, and the inferior rectus tendon is clamped through the conjunctiva for a pulling test. If the eyeball is restricted, it is positive, indicating that the inferior rectus muscle is depressed.
4. X-ray film inspection
You can choose the Fahrenheit or the tomogram to observe the sacral cavity, the sacral floor and the maxillary sinus.
