Eye fracture treatment. Fractures of the walls of the orbit

With a strong mechanical impact on the face, a fracture of the orbit may occur. The condition is accompanied by pain, crepitus at the site of injury, displacement of the eyeball. Trauma is dangerous with consequences in the form of visual impairment, strabismus, disruption of the eye muscles, and oculomotor pathologies. After an accident, you should immediately consult a doctor who will conduct diagnostics and surgical intervention, as well as give recommendations for recovery.

Why does trauma occur?

Eye structures are located in depressions on the skull - eye sockets or orbits. Due to mechanical impact, the bone walls are damaged - from the sides, from above or below. Fracture of the orbital bone of the eye occurs as follows:

Displacement occurs as a result of severe mechanical damage.

a fall;
direct trauma to the face (blow to the nose, temple, cheekbone, forehead);
boxing;
industrial or road accidents;
traumatic brain injury;
domestic or street conflicts with the use of force.

Symptoms: how to recognize damage?

One of the symptoms of a broken eye socket is emphysema, in which air enters under the skin or into the tissues of the eye.
Doctors distinguish 3 degrees of severity of injury, which are shown in the table:

Against the background of the injury, large hematomas and bruises appear.
An open injury is considered the most severe, since fragments touch and damage the nerves and muscles of the eye, which leads to complete dysfunction of the organ of vision. Damage to the bottom of the orbit provokes an infringement of the eye muscle, which causes double vision. In general, fractures of the upper wall and other areas of the orbit are manifested by the following symptoms:
severe pain in the eye;
puffiness;
hematoma formation;
blurred vision (the appearance of a whitish fog before the eyes or the image doubles);
narrowing of the palpebral fissure or complete closure of the eyelids due to edema;
hypophthalmos (omission of the eyeball);
unnatural retraction of the eye (enophthalmos);
crackling or crackling in the eye socket when trying to move the jaw.

How is the diagnosis carried out?
A fracture of the bottom of the orbit and other parts of the eye can be recognized by an ophthalmologist. The doctor conducts a visual examination, finds out the cause of the injury, determines the degree of limitation of eye mobility, the presence of a crunch, and prescribes diagnostic methods, such as:
radiography;
computed or magnetic resonance imaging;
Ultrasound of the damaged area of the eye and face.

Treatment: what methods are effective?

When is an operation required?

During the operation, measures are taken to further the correct fusion of bone tissue.
If an orbital fracture occurs, surgery is recommended. A reconstructive operation is performed, during which the damaged muscles are sutured, cosmetic defects are eliminated. If you do not see a doctor in time, when the broken eye socket has grown together incorrectly, an osteotomy is performed. The essence of the method lies in the artificial fracture of the bones at the site of the eye socket injury and their correct installation for further fusion.
If the damage to the eye is severe, an exenteration of the orbit is performed, in which all eye structures are removed, leaving only the bone cavity. After complete removal, the organ of vision is replaced with an ocular prosthesis. Drainage of the periocular zone is also used to avoid the spread of edema and visual impairment. The method of dacryocystorhinostomy, necessary for the normalization of tear outflow, is effective.

Recovery period

The use of drugs
An unburdened fracture of the lower wall of the orbit and other parts of the organ of vision is cured conservatively. Medicines are prescribed by a doctor, self-medication is prohibited. To relieve inflammation and prevent secondary infection, it is recommended to take the medications shown in the table:

Injury in the eye area, in addition to fractures of the walls of the orbit, is usually associated with additional damage to the muscles of the eye, the optic nerve, the infraorbital nerve, which is responsible for sensitivity in the cheeks, upper lip, and front teeth.

Most often, fractures of the lower and inner walls of the orbit occur. In more rare cases, fractures occur in the outer wall, which is thicker than the inner one, and in the roof of the orbit, over which the brain is located.

It is also possible to shift the eyeball to an unnatural place for it, sinking of the eyeball, restriction of eye movement due to fractures. Sometimes the above injuries are accompanied by a fracture of the upper jaw, as well as obstruction of the lacrimal ducts, due to a complex fracture.

In most cases, the presence of fractures in the orbit does not require correction. However, sometimes in case of injury, depending on the results of the examination of the eye and orbit, surgical intervention is required, the degree of urgency of which is determined by the surgeon.

Usually, surgery is needed when the eyeball has sunk in, or when the muscle is caught in a fissure, or when there is bleeding that puts pressure on the optic nerve.

Injury to this zone is very dangerous, because fractures of any of the constituent walls of the orbit are almost always accompanied by a concussion of the brain.

In addition to the combined fracture, a rare (about 16.1% of all cases) isolated orbital fracture is also distinguished, which is usually the result of a direct blow towards the eyeball.

Moreover, more often the blow occurs from the side of the lower or inner wall, that is, precisely those walls that limit the paranasal sinuses from the cavity of the orbit. Hence the name "explosive" injury.

Subcutaneous emphysema - accumulation of air as a result of traumatic "exposure" and the ingress of gas from the cavity of the orbit into the adjacent paranasal sinuses. This phenomenon is most often detected after a strong exhalation through the nose, after which the air that has entered the subcutaneous formations, as it were, “crunches” when pressed on the periorbital region.

Often there is a pinching of the lower rectus muscle, especially with a fracture of the bottom of the orbit, therefore, there is a restriction in the movement of the eye upward, and causes the development of diplopia (double vision).

In addition, hemorrhage into the muscles or surrounding tissues is possible with limitation of mobility already down.

Causes and mechanism of fracture of the orbit of the eye

Orbital fractures are usually caused by blunt trauma. For example, a blow received on the steering wheel or seat during an accident or hit by a tennis ball. Even just a punch to the eye with great force can lead to such consequences. In this case, the eye and tissues of the orbit are very often injured. It is also worth remembering that fragments of the eye socket can damage the tissue of the eye.

When injured with a sharp object, the bone may be slightly damaged, and symptoms of damage to the eyeball will come to the fore.

Note! The most dangerous type of injury is a gunshot wound. It significantly damages soft tissues, crushes the bones of the eye socket and other areas of the skull, and can affect the brain.

Falling on an object from a great height or from a height of human growth;
A strong blow with a blunt or sharp object in the eye socket;
Impact on the victim with a firearm;

Classification

Fractures of the orbit are classified according to the anatomical component.

It is important for specialists not only to detect the fracture site, but also to diagnose the entire area of damage, to find out how strong the blow was and as a result of which it was received.

Fractures of the orbit differ depending on the location of the damage - the medial, lower, upper or inner walls of the orbit.

Isolated fractures of the walls of the orbit

An isolated fracture is a fracture in which only the inner walls of the orbit are damaged. At the same time, its edges, like other parts of the facial skeleton, remain intact. Such damage is quite rare. The cause of an isolated fracture may be a blow to the orbit with a small diameter object.

Most often, along with the inner surface, the outer edges of the orbit break. Such a fracture can no longer be called isolated.

According to the damage
- firearms;
- Non-firearms.
By type of damage:
- Isolated fracture;
- Fracture, combined with trauma to the eyeball;
- Combined fracture (with damage to the bones of the brain and facial skull, as well as the paranasal sinuses located next to the fracture);
- Fracture with the presence of a foreign body in the orbit.

Non-gunshot wounds are divided into:

Orbital injuries and soft tissue contusion;
Open fracture of the bone walls of the orbit;
Closed fracture of the bony walls of the orbit.

Wounds of the soft tissues of the orbit are divided into:

Torn;
cut;
Stab.

Currently, according to statistics, the most common among injuries of the orbit is a fracture of the bone walls of the orbit.

Fracture of the bone walls of the orbit is divided into:

Closed fracture of the bone walls;
An open fracture of the bone walls (in this case, the orbit communicates with the external environment).

The eyeball is located in the deepening of the skull. It is called an orbit, in which there are walls, a top and a base. In case of injury, the bone tissue is damaged, this leads to a fracture of the eye. Depending on the damage to the skin, fractures are:

closed - are inside;
open - damage the skin.

According to the severity of the injury are divided into:

a fracture with a displacement (in this case, one cannot do without the help of a surgeon);
injuries without displacement;
cracks without fracture.

According to the timing of the operation, early surgical intervention is performed, performed in the acute period of injury, within the first two weeks, that is, precisely in the period of time when there are the most optimal conditions for restoring the integrity and ensuring adequate physiological functioning of the affected organ.

Also, the operation can be delayed, performed after a two-week period, but up to the fourth month after the injury. This is the so-called "grey period".

And, finally, late medical care, requiring mandatory osteotomy.

The most effective methods of treatment include surgical, in which there are several methods for correcting the bone tissue of the orbit and zygomatic arch. All of them are similar in that they are made through small incisions, which then heal, that is, they become completely invisible.

This operation can be performed from the side of one of the walls of the orbit, may include providing extended access to the opening of the fracture area and the subsequent possibility of using various types of prostheses.

Signs of an eye fracture

Regardless of the type of fracture, the following symptoms are observed:

Intense pain in the area of the affected eye socket;
Significant swelling of the tissues around;
Severe subcutaneous hemorrhage;
Retraction or bulging of the eyeball;
Crunch of bones when pressed;
Decreased visual acuity.

Symptoms

Symptoms of fractures can be divided into direct and indirect.

Direct signs of fractures:

Symptom "steps" - a palpable irregularity ("ledge") in the region of the edge of the orbit, violating its smoothness and continuity. In recent cases, the "step" area is often accompanied by local pain.
Deformation of the periorbital (zygomatic, infraorbital, nasal) areas, capturing the edge of the orbit or its entire wall and visible when examining the patient.
The presence of direct signs of a fracture (fracture line, displacement from fractures, deformation of the contours) with radiation and other research methods (radiography, computed and magnetic resonance imaging, ultrasound) (Fig. 121).

Indirect signs of fractures:

Emphysema of the orbit and eyelids, associated with the ingress of air into the tissue of the orbit and subcutaneous tissue of the eyelids from the paranasal sinuses (and primarily from the ethmoid) as a result of a fracture of the walls. Emphysema of the orbit is manifested by exophthalmos, emphysema of the eyelids - an increase in the volume of the eyelids and crepitus during their palpation examination. On the radiograph, the cellular structure of tissues containing air (small areas of increased airiness) is determined.
Dislocation of the eyeball down and backwards (enophthalmos, especially early) due to an increase in the volume of the orbit as a result of mixing of fragments in the direction from the orbit. This symptom in the first days after injury can be weakened by a temporary increase in the volume of the contents of the orbit due to traumatic edema and hemorrhages. On the 5-7th day after the injury, in the presence of a fracture with displacement, this symptom becomes apparent. The omission of the eyeball is sometimes seen on the x-ray as an expansion of the space between the shadow of the eyeball and the upper wall of the orbit (Fig. 122). Very rarely, when a bone fragment is displaced inside the orbit, a fracture of its walls is accompanied by exophthalmos. It is possible to shift the eyeball horizontally (right-left) towards the damaged wall of the orbit (Fig. 123). The dislocation of the eyeball in combination with the restriction of its mobility leads to diplopia.
Restriction of passive mobility of the eyeball, determined using the “traction test” After preliminary terminal anesthesia (dicain 0.25% epibulbarno, 3 times), the researcher with tweezers through the conjunctiva captures the muscle, the infringement of which is supposed to be, at the site of attachment to the eyeball, and moves the eyeball in the direction opposite to the action of this muscle (for stretching). At the same time, the limitation of the mobility of the eyeball indicates the fixation (infringement) of the examined muscle or tissues surrounding it.
Violation of skin sensitivity in the zone of innervation of the infraorbital nerve (the inner half of the infraorbital region, the wing of the nose, the upper lip, and sometimes the upper teeth on the side of the fracture) due to its damage during a fracture of the lower wall of the orbit.
A decrease in visual acuity or a complete loss of it can be observed when a fracture is localized at the top of the orbit with damage to the optic nerve.
Long-lasting and not intense exophthalmos may indicate liquorrhea into the orbital cavity.
Pulsating exophthalmos is associated with rupture of the internal carotid artery in the cavernous sinus when the upper wall of the orbit is damaged.
Indirect radiological signs of fractures of the walls of the orbit associated with changes in the paranasal sinuses.
Violation of lacrimal drainage is often a sign of a fracture of the inner wall of the orbit with damage to the lacrimal canal.

Symptoms of contusion of the soft tissues of the orbit (external muscles of the eye, fiber, optic nerve) are listed below:

Exophthalmos due to edema and hemorrhage. Swelling of the soft tissues of the orbit may be accompanied by edema of the eyelids and chemosis. Hemorrhages in the orbital cavity can be parietal or in the form of a retrobulbar hematoma. Parietal hemorrhages from peripheral small vessels, depending on the severity, can, like traumatic edema, cause moderate exophthalmos, in which the eyeball is rather easily repositioned posteriorly. Hemorrhage can spread under the conjunctiva and be accompanied by hemorrhage into the thickness of the eyelids. Early hemorrhages indicate damage to the soft tissues of the orbit, eyelids. Late hemorrhages, appearing on the 2-3rd day, may indicate fractures of the base of the skull. Retrobulbar hematoma is a hemorrhage from the central (larger) vessels into the muscular funnel, which is a closed cavity formed by the external muscles of the eye and the funnel part of the Tenon capsule (Fig. 124).
An increase in pressure in the muscle funnel causes a significant (up to 10 mm) intense exophthalmos. The degree of exophthalmos is directly dependent on the degree of contusion of the soft tissues of the orbit. However, the absence of exophthalmos is not always a sign of a favorable condition of the soft tissues of the orbit. Fracture of the walls of the orbit, increasing its volume, can hide (compensate) exophthalmos, indicating a severe contusion of the soft tissues of the orbit.
Decreased visual acuity as a result of damage or compression of the optic nerve by a retrobulbar hematoma.
Restriction of the mobility of the eyeball as a result of severe contusion of the muscles, nerves, fiber of the orbit, accompanied by circulatory disorders, innervation, hemorrhages, swelling of the muscles and tissue. Mild contusion changes can be reversible, which manifests itself in the expansion of the range of motion of the eyeball 5-7 days after the injury. As a result of severe contusion, after 1-2 months, cicatricial atrophic processes can develop in the external muscles of the eye, Tenon's capsule, orbital tissue, which are little susceptible to reverse development.

DIAGNOSIS OF CONTUSION INJURIES OF THE EYE

When starting the examination and treatment of victims with fractures of the walls of the orbit, it is necessary first of all to exclude damage to the skull, brain and other organs, since these complications can threaten the life of the patient.

The diagnosis of damage to the orbit is based on:

history;
data of radiation research methods;
examining the patient and identifying visible deformations of the edges and walls of the orbit, changes in the organs and areas adjacent to the orbit;
determination of violations of the position and mobility of the eyeball;
binocular vision disorders, diplopia (Fig. 125).

To diagnose violations of the position of the eyeball, measurements of its vertical displacements relative to the horizontal line passing through the pupil of a healthy eye, and horizontal displacements relative to the vertical midline of the face are used.

They are usually made using two rulers at right angles to each other. One of them is located along the measurement axis, the second is used to measure the deviation of the eyeball from this axis.

Measurement of anteroposterior displacements is performed using a Hertel exo-ophthalmometer. The express method for detecting these shifts is as follows.

The patient, throwing his head back, transfers the plane of the face from vertical to horizontal, the gaze directs perpendicular to the plane of the face (at the ceiling) (Fig. 125).

The doctor, observing the protrusion of the eyeballs from the side of the chin, can even note a slight difference in their position.

The study of the mobility of the eyeballs is performed on the perimeter of the Foerster by determining the field of view.

Diplopia is determined by the method of double images according to Gaab or by the method of coordimetry on the Lancaster grid. The presence of binocular vision is determined using a color test, as well as using Bagalini glasses or a Maddox prism.

Determination of the zone of binocular vision can also be made on the perimeter using red glass, denoting the boundaries of the areas of the field of view where there is no doubling. With a deep disorder of binocular vision, when doubling persists in all directions, this method is not applicable.

In order to exclude the infringement of the muscle in the fracture zone when the mobility of the eyeball is limited, a “traction test” is performed.

If the study of the position and mobility of the eyeball is difficult due to a sharp edema and hematoma of the eyelids, you should adhere to expectant tactics for several days. During this period, rest, cold, osmotic agents are prescribed.

The patient is examined by an otorhinolaryngologist, and, if necessary, by other related specialists, and their recommendations are followed. If within 5-7 days the range of motion of the eyeball has not expanded, if signs of displacement of the eyeball have appeared (intensified), a positive “traction test” is noted and diplopia is preserved, especially when looking directly or close to this position (about 5 ° from the fixation point). ), in this case (if there are radiological signs of a fracture), surgical intervention is necessary.

With positive dynamics, the operation can be delayed, but not more than 10-14 days after the injury. On the 14th day, a final decision should be made using computed tomography data.

With direct signs of a fracture of the walls of the orbit, leading to a violation of the mobility and position of the eyeball, accompanied by functional disorders (decreased vision - diplopia), surgical intervention is indicated in the early stages.

The main signs of fractures of the orbital bone are acute pain and restriction of eye movement, double vision, restrictions in facial expressions and mouth movement, the formation of air bubbles under the skin near the eyes, as well as in their mucous membrane, indentation (enophthalmos) or bulging (exophthalmos) of the eye, reduction facial skin sensitivity.

Epistaxis, swelling around the eyes can be observed as secondary signs. Often, damage to the upper bone wall of the eye is accompanied by a violation of the brain. In case of a fracture of the lower wall of the orbit, infection from the nasal cavity to the mucous membrane of the eye may occur, which increases the severity of the patient's condition.

By their nature, the upper arch of the orbit has a strong bone structure, therefore, in case of damage, a fracture of the lower wall of the orbit most often occurs.

How to determine the fracture of the orbital bone? Doctors identify the following symptoms:

swelling, stiffness of the movement of the eyeballs and pain;
state of shock with elements of blurred vision;
a decrease in the level of sensitivity of the infraorbital nerve, and therefore, the backs of the nose, cheeks, eyelids, upper teeth and gums;
split field of view;
ptosis (flattening of the eyelid);
with serious injuries - displacement of the eyeball;
bleeding and internal hemorrhage;
the presence of air in the subcutaneous zone and visible bubbles in the tissues.

Pain in the eye socket;
The victim complains of "blurring" vision (this symptom is due to the state of shock);
In a patient, all nearby objects “double” in the eyes;
At some victims the hypostasis in the field of a century is expressed;
When examining a patient, a pronounced hematoma in the eyelid area attracts attention;
As a result of edema and hematoma, the patient has a narrowing of the palpebral fissure;
Restriction of the mobility of the eyeball;
The victim has exophthalmos or enophthalmos;
With a fracture of the orbit of the eye, the patient has ptosis (drooping of the outer corner of the eye);
Some patients may experience subcutaneous emphysema (crepitus);

With massive injuries, small areas of fatty tissue can be observed in the wound, damaged external muscles of the eye and ophthalmoplegia.

A doctor can help you heal your injury. The main thing is to find the problem behind the different symptoms.

The main symptoms of a fracture of the lower orbit of the eye:

Swelling of the area around the eye.
Weak mobility of the eyeball.
Diplopia - bifurcation of objects.
Enophthalmos - displacement of the eyeball into the orbit, or vice versa (exophthalmos).
Crunch in the lower part of the eye socket.
Severe pain in the eye area.
The presence of hematomas.

Diagnostics

At the first stage of the examination, it is necessary to conduct a thorough examination of the patient's injured organ of vision for the presence of eyelid edema, for the motor ability of the eyeball, for the sensitivity of the skin around the eye, and to measure intraocular pressure.

For a more accurate examination, if there is a suspicion of bone damage, and the x-ray did not show this, a computed tomography is performed. But this research method also has its drawbacks - the irradiation of the lens, and also due to the presence of edema, it can only be carried out after a while.

To diagnose eye injuries, magnetic resonance imaging (MRI) can be used as an auxiliary method. This method can reveal muscle pinching in the fracture zone, fluid accumulation in the orbit.

Recently, the method of ultrasound examination of injuries of the orbit has become more common. With the help of ultrasound, it is possible to determine both damage to the orbit, and to identify the presence of an injury to the eyeball, the condition of the optic nerve and eye muscles.

Upon admission to the trauma department, the patient is sent for x-rays. The doctor first examines the patient for a factor of pronounced fracture phenomena, if the lower wall of the orbit is broken, then the patient has a hematoma of the eyelid, subconjunctival hemorrhage (the entire area of the white of the eye is filled with blood), and a tumor of the eye membrane.

The examination begins directly with a complete examination of the patient's head, facial part, they check the reaction to external stimuli and conduct a study of the nerve endings of the cranial box.

In the department of ophthalmology, the patient is examined for suspicion of severe injuries: rupture of the white of the eye, pinching of the optic nerve, high pressure in the region of the orbital cavity.

To detect violations of the motility of the eye, a test with artificial bifurcation (diplopia) is used. The ophthalmologist and the patient sit at a distance of two meters from each other, a translucent red glass is applied to the damaged eye.

The doctor picks up the switched on flashlight and moves it in different positions, after which the patient is asked how many images of the light bulb he saw. If there were two or more images, then the patient is asked to report in what position, vertical or horizontal, and at what distance from each other they were.

The next step is to carry out differential diagnostics to identify difficult rotations of the eyeball in the victim. To do this, use the "traction test": the patient looks at his hand, stretched out in the area of the alleged displacement.

After local anesthesia of the affected area, the eyelids of the injured orbit are fixed with a special object, while the eyeball is displaced in the opposite direction from the presumably pinched muscle.

With a positive "traction test", pinching of the nerve of the lower orbital arch in the area of the fracture is detected. It is difficult for the patient to move the eye up and down. In rare cases, diplopia develops and surgery is required.

Negative result of the "traction test": the patient has a slight displacement of the eyeball in the upper region, while he can freely move it towards the floor. The eye socket is fixed in a similar way as in the previous test, the patient is asked to look at the floor with the injured eye, the specialist must feel the convulsive contraction of the nerve endings and identify the specifics of the damage.

Usually, paralysis is associated with severe bruising of the muscles of the orbit and disappears within two weeks, if the motor function of the eye has not recovered, the optic nerve is re-diagnosed.

After all the procedures for examination and diagnosis, the patient is transferred for treatment to the ENT department.

Upon receipt of a fracture of the orbit and admission to the hospital, the doctor conducts an examination, urgently prescribes an X-ray examination, CT and MRI. The results of the study allow you to accurately determine the degree of damage to the injury, prescribe the appropriate treatment.

The most informative in case of a fracture of the left or right eye socket is computed tomography or magnetic resonance, which allow to determine the slightest changes in the structure of bone and muscle tissue with an accuracy of 98%.

Collection of anamnesis (mechanism and circumstances of injury);
Examination of the organ of vision and lacrimal canals;
Radiography of the orbits and paranasal sinuses;
Tomography of orbit damage;
Ultrasonic diagnostics of orbit damage;
Consultation of the victim with a dentist, otolaryngologist, neurosurgeon.

First you need to go through a traumatologist and an ophthalmologist. Doctors will examine the injury, examine the patient's symptoms, and make a diagnosis. To determine the severity of the injury, the patient will be sent for procedures:

X-ray - will allow you to examine the injury in more detail. This procedure will help determine the severity and location of the broken bone.
Magnetic resonance imaging - will determine the general condition of the orbit. After carrying out all the above procedures, the patient will be prescribed treatment, he will be referred to specialized doctors who will begin the treatment of the patient. A complex operation can also be prescribed, but this is only if, in addition to the orbit, other parts of the face are also damaged.

Signs of proptosis and prose are found in a significant part of the victims, as a result of traumatic hemorrhage in tissues and muscles and swelling in the facial region of the skull. On examination, foreign bodies of various sizes and structures can be detected.

Approximately 30% of all “explosive” orbital fractures are combined with the development of corneal erosion, traumatic hyphema (the presence of signs of hemorrhage in the anterior chamber), iritis (inflammation of the iris), rupture of the eyeball, signs of retinal concussion, its detachment, and, finally, hemorrhages.

The severity of the fracture of the orbit is high.

Computed tomography (CT) is preferred, and axial and coronal thin sections are desirable for better understanding of the state of the orbital walls.

To detect a fracture and introduce the contents of the orbit into adjacent sinuses, it is necessary to examine the inner (medial) part of the bottom and the wall adjacent to the nasal bone.

Examination of the bone top allows you to identify the condition of the posterior edge of the bone, which is mandatory during surgery.

The main manifestations depend on the strength of the applied blow to the facial part of the skull and associated injuries: for example, with a fracture of the predominantly upper wall, the percentage of brain concussion is high. In case of a fracture of the lower or inner (medial) wall, mucous membrane secretions may spread through the lesions into the paranasal sinuses with concomitant infection.

Treatment

Diagnosis and surgical treatment of combined injuries of the orbit should be carried out with the participation of related specialists. The need for the participation of related specialists can be determined both in the preoperative period and, often, during the performance of a surgical aid (intraoperative diagnostics).

In case of a fracture of the upper wall of the orbit during the operation, the help of a neurosurgeon may be needed. An otorhinolaryngologist in these cases is necessary for the imposition of an anastomosis between the frontal sinus and nose.

In case of fractures of the zygomatic and maxillary bones with a displacement requiring reposition of fragments, the operation is performed by a maxillofacial surgeon with the participation of an ophthalmologist. The task of the ophthalmologist is to free the tissues of the orbit from the fracture zone, and, if necessary, to repair the walls of the orbit.

In addition, the ophthalmologist controls the adequacy of the performed benefit in relation to the eyeball and optic nerve. In case of fractures of the lower and inner walls of the orbit, the operation is performed by an ophthalmic surgeon with the participation of an otorhinolaryngologist, or at least in his presence.

The tactics of the ophthalmic surgeon determines the condition of the eyeball. According to the relevant indications, it is necessary first of all to perform a surgical intervention on the eyeball, and only then to do plastic surgery of the walls of the orbit.

The time between these operations is determined individually, depending on the nature and severity of the damage, the extent of the surgical intervention, the expected recovery of functions and the experience of the surgeon in performing operations on the orbit.

During the first two days after injury, it is necessary to apply cold to the damaged area. For one to two weeks, vasoconstrictor nasal drops and antibiotic therapy are prescribed.

Also, in the first days, the patient needs to ensure peace, since fractures of the walls of the orbits can be accompanied by brain injuries. Corticosteroids are sometimes prescribed to reduce inflammation.

With minor injuries, if the patient's condition allows, it is possible to carry out surgical operations to reconstruct the bones during the first three days. In severe cases, with severe edema, persistence of double images and pronounced enophthalmos, the operation can be performed after 1-2 weeks.

Early surgery (within the first 10 days) is preferred over later.

If the upper wall of the orbit is damaged, the patient should be examined by a neurosurgeon, possibly with further hospitalization in the neurosurgery department.

The examination should be carried out very carefully in order to determine all damage and subsequently reduce and fix all bone fragments.

To fix bone fragments, interosseous wire sutures are applied or microplates and screws are used. To restore the walls of the orbit, primarily the lower one, bone grafts are used, which are made from dissolved cartilage tissues and bones of the ribs, skull, tibia, or inorganic implants.

Structures made of titanium, silicone, Teflon, etc. are used as inorganic fragments.

Often, during the operation, it is necessary to consult an otolaryngologist and a maxillofacial surgeon.

First, the patient is prescribed a course of antibiotics, the victim should be warned about the danger of blowing his nose. Next, the victim takes classes in visual gymnastics and restoration of the rotational motility of the apple. Preventive treatment is also prescribed to prevent the development of diplopia and pupil deformity.

Ordinary fractures of the lower wall of the orbital orbit are not operated on; in most cases, the patient does not suffer from neurological disorders and pronounced deformity of the facial bone. In more severe cases, surgical intervention is required. The operation should take place at an early stage after an accurate diagnosis. Indications for surgery:

severe visual impairment and double vision;
displacement of the eyeball by a gap of more than 2 millimeters;
fracture of a large area of the lower wall of the orbit;
severe dysfunction of the optic nerve;
permanently enlarged lens of the eye;
non-perception of the supply of light pulses to the iris.

In the postoperative period, the patient is prescribed intravenous injections, and muscle injections with bone-building substances are also prescribed.

Based on instrumental diagnostic methods, the doctor decides on treatment, which can be performed conservatively or surgically. An emergency operation is performed only in cases where the eyeball falls inward, the patient has severe bleeding or damage to the optic nerve.

In case of minor damage to the eyeball or in cases of a linear fracture, treatment can be carried out in a conservative way, which includes applying a tight bandage to the sore eye, taking painkillers and anti-inflammatory drugs. The vast majority of conservative treatment is 2 weeks.

Sometimes doctors delay the operation, citing excessive pressure on the eyeball, but in such cases there will always be a risk of damage to the optic nerve, which will lead to blindness.

Despite the advances in modern ophthalmology, it is impossible to fully restore vision after a fracture of the eye socket. Very often, after an injury, patients lose their sight, therefore, in order to minimize all kinds of risks and complications, after an eye injury, you need to seek help from a doctor as soon as possible, but it is better to be more careful about your health and prevent such injuries.

The goal of treatment for such fractures is to restore the previous state of the orbital bone (as far as possible). Also, medical measures are taken to regulate the position of the eye, restore its motor functions. If the fracture is not complicated, then the doctor may prescribe a conservative treatment for such a fracture.

Such treatment, in most cases, is rarely prescribed. For the treatment of fractures of the orbit, surgical intervention is used. All this is done in the first hours to reduce pressure on the eye and prevent hemorrhage in the eye area. If the pressure on the optic nerve increases, then the patient feels a partial progressive loss of vision.

There are two ways to treat this injury:

Conservative. It helps in case of an isolated small fracture without displacement of the bones of the orbit. In this case, the eye is treated with antibiotic solutions and a special bandage is applied to it. The procedure is repeated daily for 2 weeks.
Operational. It is used in the event that the bones of the orbit need to be returned to their previous position or to eliminate damage to soft tissues. In this case, surgical intervention is carried out, the volume of which depends on the number of damaged structures. For example, fragments of the eye socket can be removed from the cavities, the muscles and tissues of the eyeball can be stitched together, the eye socket can be cleaned of blood, pus, and much more.

Regardless of the method of treatment, the patient must take pain medications and oral antibiotics.

First aid consists in treating the wound with a disinfectant solution and applying an aseptic bandage.

The goal of surgery for significantly displaced midface fractures involving the orbit is to prevent the development of enophthalmos, as well as dystopia of the orbit and canthal ligaments.

Restoration of the complex three-dimensional spatial anatomy of the orbit;

The release of the contents of the orbit, restrained in the fracture;

Reduction of hernial protrusion of the contents of the orbit;

- reposition of the eyeball.

Stabilization and reconstruction of the orbital ring (medial, lateral, upper and lower edges of the orbit);

Reconstruction of defects in the bottom and, if necessary, other walls of the orbit to restore the size of the cavity of the orbit.

Repair of damage to the soft tissues of the orbit, including the position of the medial and lateral canthal ligaments.

Bone autografts - split bones of the cranial vault, ribs, iliac crest, tibial tuberosity.

Bone or cartilage homografts

Inorganic allografts (titanium structures, silicone, Teflon, etc.).

Any material that is used for bottom reconstruction should preferably be fixed to avoid displacement or extrusion.

If it is possible for the graft to come into contact with the maxillary sinus, the ethmoid labyrinth, autologous bones or titanium structures should be used to reconstruct the orbital walls, since in these cases there is a minimal risk of developing inflammatory complications.

The most common complications of inadequately treated orbital floor fractures are diplopia, enophthalmos, and limitation of eyeball mobility in the vertical plane (Fig. 16-15). Fractures of the medial wall of the orbit often accompany fractures of the orbital floor (Figs. 16-19) and are sometimes an unrecognized cause of residual postoperative enophthalmos.

When reconstructing the bottom of the orbit in order to eliminate diplopia and enophthalmos, maxillofacial surgeons in our country quite often use transantral access. After the eyeball is repositioned, the orbital floor is reconstructed with a titanium F-shaped plate or titanium mesh inserted into the orbital cavity at an angle sufficient to eliminate enophthalmos.

The plates are fixed in the region of the infraorbital margin and the posterior wall of the maxillary sinus.

Early surgery (within the first 10 days after injury) is preferable to late surgery. Only for vital or local, from the side of the orbit and the eyeball, contraindications, the operation can be postponed.

S.A.Eolchiyan, A.A.Potapov, F.A.Van Damme, V.P.Ippolitov, M.G.Kataev

Principles of therapy

Simple periosteal orbitotomy and drainage of the retrobulbar space in retrobulbar hematoma. The operation is usually performed under local infiltration anesthesia with a 0.5-2% novocaine solution.

Percutaneous periosteal orbitotomy is performed through an incision along the lower edge of the orbit. If, according to the data of computed tomography, magnetic resonance imaging or ultrasound, a more accurate localization of the hematoma is known, the incision is made according to its localization: along the upper, outer or lower edges of the orbit.

Parallel to the edge of the orbit, a layer-by-layer incision of the skin and subcutaneous tissue is made with a scalpel.

The fibers of the circular muscle of the eye can not be cut, but moved apart, having previously stretched them with the branches of the tweezers brought under the muscle. To avoid eyelid retraction in the postoperative period, the skin incision (2.5-4 cm) should be located no closer than 5 mm from the edge of the orbit.

To prevent the formation of a rough scar soldered to the periosteum, it is desirable to shift the incision of each layer to the edge of the orbit by 1.5-2 mm. In order for the skin incision to coincide with the folds of the face or existing scars, the projection of the upcoming incision should be marked before anesthesia.

Bleeding from the wound can be stopped by diathermocoagulation or clamping followed by ligation of the vessel. Bleeding from small vessels usually stops on its own or after point massaging movements with a gauze ball.

The tarsoorbital fascia is dissected directly at the edge of the orbit. The contents of the orbit are stupidly separated from the wall and lifted up with a spatula.

If, after expanding the wound deep into and to the sides, blood is not obtained, then the space of the muscle funnel should be opened. To do this, in the lower outer quadrant, the tip of the “mosquito” is passed through the parabulbar tissue between the muscles of the eye towards the posterior pole of the eyeball to a depth of 1-1.5 cm. Expanding the jaws of the clamp, break the funnel part of the Tenon capsule.

In order to avoid damage to the optic nerve, all actions of the surgeon must be as careful as possible. A sign of the effectiveness of the manipulation is the appearance in the wound of loose bright yellow funnel fat or blood from a retrobulbar hematoma.

Even if the outflow of blood is not obtained during the operation, the orbitotomy itself will reduce the intraorbital (more precisely, retrobulbar) pressure caused by swelling of the tissues or soaking them with blood, and eliminate compression of the optic nerve.

As a variant of the retrobulbar hematoma approach, the transconjunctival approach, commonly used in ocular muscle surgery, can be used. Stupidly pushing the tissues apart at a depth of 3 cm from the place of attachment of the muscles to the eyeball, the retrobulbar space is opened and drained.

The operation ends with drainage of the retrobulbar space for 1~2 days with a strip of glove rubber or a perforated polyethylene tube. The wound is sutured in layers with synthetic monofilament (Perlon, 5/0-7/0).

The use of catgut should be avoided as it sometimes delays wound healing. In the postoperative period, it is advisable to prescribe osmotic therapy, topical steroids.

The cost does not include the cost of the implant, which depends on the type of injury and the amount of damage. The final price is determined by the ophthalmologist during a face-to-face consultation. Estimated price of the implant is $350.

The patient can be discharged home a few hours after the operation. However, in some cases, hospitalization may be necessary. The decision on the need and duration of hospitalization will be made by the operating surgeon at the end of the operation.

The cost of one day of hospitalization - $ 780

First, the patient needs first aid. It is required to treat the injury site, and then apply an antiseptic bandage.

After that, in a short time, you need to call for medical help. In the event that the patient managed with a slight injury - a linear fracture, it can be treated conservatively.

The patient should not be heavily loaded airways. This method can also be prescribed if surgery can cause complications due to excessive pressure on the orbit.

If, on the contrary, the fracture is of high severity and is accompanied by deterioration or loss of vision, it is necessary to resort to surgical intervention. During orbital fracture surgery, the doctor will remove dead tissue and rebuild the bones.

The types of operations are divided into 3 types:

early surgery - performed within 2 weeks after the fracture, is the most effective;
operation of the "gray period" - from 2 weeks to 4 months after the injury;
late surgery (osteotomy) - 4 months or more.

Includes medication:

Painkillers. For example, "Analgin".
Anti-inflammatory. You can also combine the first two properties and buy non-steroidal anti-inflammatory drugs (NSAIDs), which relieve pain and reduce inflammation. For example, "Nurofen", "Ibuprofen", "Ketorol", "Nise" and many others. Most of them can be bought with a prescription, but there are over-the-counter products that also work well.
antibiotics. Released strictly by prescription! Perhaps the doctor will prescribe drugs that help restore bone tissue. For example, "Mummy".
Vitamin-mineral complexes or drugs that strengthen the immune system (immunomodulators). It is also very important that the patient follow all the doctor's recommendations for a speedy recovery. He also provided himself with rest, ate healthy foods (vegetables, fruits) and limited eye strain.

A full rehabilitation complex lasts from 2 weeks to 2 months. The first days of rehabilitation should be under the supervision of a doctor. The bone itself is restored up to 3 months, healing is divided into 3 stages:

1-10 days after the fracture - the body moves away from the injury;
10-45 days - primary callus is formed;
up to 3 months - complete formation of callus.

The goal of treatment is aimed at preserving or restoring the structure of the orbit and its contents, that is, the eyeball (restoring the range of motion of both active and passive muscles, eliminating such unpleasant accompanying symptoms as diplopia or, for example, strabismus, causing significant discomfort to the victim).

Often in this situation, they resort to surgical intervention, which at the same time has an adverse effect on the contents of the orbit, manifested in the form of excessive pressure on the eyeball.

The danger also lies in the fact that the hemorrhage that occurred behind the eye several times increases the pressure exerted on the optic nerve, and mainly on its disc, which entails not only a deterioration in vision, but also in an unfavorable outcome and its complete loss.

Since the injury also involves a lot of other anatomical components of the skull, therefore, the load on these affected parts is also prohibited, in particular, the pressure exerted on the airways. A simple effort, even a slight one, for example, when blowing your nose, leads to an increase in pressure inside the cavity of the zygomatic arch, which exacerbates swelling and can provoke a complete closure of the eye, or contribute to the development of subcutaneous emphysema.

First aid for a fracture of the orbit of the eye

In case of a fracture of the eye socket, it is best to immediately call an ambulance. If the condition of the victim is serious, then before the arrival of the doctors, it is necessary to provide first aid:

Frequent with such injuries is nosebleeds, which are caused by damage to blood vessels during a blow. It is contraindicated to tilt your head back. To stop bleeding, you need to put cotton turundas in the nostrils.
To reduce swelling, you can apply cold under the eye.
Any disinfectant solution is used to wash wounds, but not peroxide.

The ambulance will take the victim to the trauma department, where all emergency measures will be taken and the necessary diagnostics will be performed.

Consequences

The prognosis, both for life and for working capacity, is quite favorable if rehabilitation was carried out fourteen days after the injury.

Damage to the ocular nerves and muscles is not ruled out. If damage to various structures of the eye is detected, then full recovery occurs only within four months. In severe cases, recovery may not occur.

Damage to the outer and inner walls of the orbit can lead to a fracture of the optic nerve canal, which in turn can cause damage to the optic nerve itself, and, as a result, irreversible loss of vision.

To avoid losing the ability to see, urgent surgery is needed to remove bone fragments that could be causing nerve damage and to prevent hemorrhage inside the optic canal.

In case of violations of the inner wall, one should refrain from sneezing and sudden inhalation of air in the first few weeks, for this it is necessary to prohibit physical activity and ensure complete rest for the patient, as well as carry out regular wet cleaning and ventilation of the room, observe the level of humidity and temperature conditions of the room.

In different cases, depending on the severity of the damage, there may be consequences. To prevent complications in any eye injury, an urgent visit to a doctor is necessary.

If you conduct an examination in a timely manner and prescribe the necessary treatment, then basically the patient's condition is restored without any problems. Sometimes, with severe injuries and cosmetic disorders, plastic surgery may be required in the future.

It is not recommended to delay the visit to the doctor in case of eye injuries, even if, in your opinion, there are no superficial changes.

Only a specialist can determine the degree of damage, prescribe the correct treatment, which will help to avoid consequences altogether. Failure to follow the doctor's recommendations can lead to serious complications, namely, irreversible loss of vision.

A patient with eye injuries must be under the supervision of a doctor for a month. After 20-30 days, it is necessary to conduct an examination of the retina and protein of the damaged eye in order to prevent possible retinal detachment, glaucoma and inflammation of the eye tissues.

When a strong swelling of the tissues of the orbit has subsided, after 5-10 days, the patient should be examined to identify the development of chronic bifurcation of the image or enophthalmos. These symptoms may indicate pinching of the eye muscles, which requires a mandatory surgical operation.

If treatment is not carried out, then 15-20 days after the injury, tissues grow between the bone fragments and scars form, the bones are fused. Bone fragments, collapsing, form rough scars that are not able to perform the functions of the bone skeleton. The violations obtained in this case are irreversible.

The consequences directly depend on the severity of the injury. Sometimes, in the place where the fracture occurred with displacement, a bone defect is formed. Displaced areas are simply removed, leaving part of the eye socket empty.

If the defect is large enough, tissue plastic surgery is performed. In other cases, the role of the wall takes on a dense scar.

The most severe are the consequences of soft tissue injury. With severe damage to the eye, it is simply removed, leaving the eye socket empty.

Sometimes an eye injury leads to a complete loss of the ability to see or a sharp deterioration in vision.

In addition, impaired mobility of the eyeballs and their displacement can remain with the victim for life.

A fracture of the orbit of the orbit can lead to the following complications:

Facial deformity.
Visual impairment.
Strabismus, diplopia.
Poor mobility of the eyeball.

Timely access to a doctor will reduce the risk of these complications. If you do not consult a doctor for a certain time, the patient's condition will worsen.

In the absence of treatment, 2 weeks after the fracture, fibrous adhesions begin to form, the bone walls of the eye orbit begin to collapse. Scar tissue begins to form, due to which the deformation of the face occurs.

After 3 months, the deformation is considered formed.

If treatment is not started on time, after the hematoma has formed, fibrin strands are deposited over time, and as a result, fibrous adhesions form. With which then it is necessary to struggle long and painfully.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped, it only got worse ...

Of course, there may not be a fracture of the eye socket, frontal bone (and other parts of the skull), but it is likely that a person who has received a strong blow to the head can get a concussion. Therefore, do not delay a visit to a traumatologist. Now let's focus on a very dangerous type of bone loss - a fracture of the eye socket.

Why is a fracture of the eye socket dangerous for a person?

First of all, the visual organ and nerves that serve the eye can be injured. Fragments of bone can injure this delicate organ so much that it can no longer perform its functions, irreversible processes can develop that will lead to loss of vision. Even improper treatment of such a fracture can lead to the development of inflammatory processes, disruption of the proper functioning of the nasal part of the head. Purulent processes are very dangerous for this part of the human body and can be fatal. The main reasons for the formation of purulent processes:

Open fractures, when the integrity of the skin is violated.
Remaining bone fragments not removed surgically.
The presence of a foreign body.
Decreased immune response of the body, various disorders in the immune system.

In the emergency department of the hospital, the doctor immediately inspects the injuries in a patient with a head injury, assesses their degree and the urgency of providing first aid. The only examination that can give a complete diagnostic picture of fractures is an X-ray examination. A snapshot of the skull will show the doctor the state of the orbit, other parts of the skull. According to the X-ray examination, the primary strategy for treating the patient will be built. Some anatomical information: in medicine, the eye socket is the place where the organs of vision are located. It is a recessed bony cavity that connects to other parts of the skull.

Features and complexity of such fractures

The complexity and danger of fractures of the orbit is explained by the fact that it protects very important organs for life - the visual and brain. Nearby are important nerve trunks. The more complex such a fracture, the more dangerous it is for life, and the treatment and rehabilitation are very long.

These types of fractures are still dangerous because they are very rarely diagnosed as isolated. A common thing is that a fracture of the orbit is combined with other bone sections of the skull. Very often, the eye socket breaks along with the temporal, frontal and zygomatic bones, and the nasal ones are also damaged. They are all nearby, interconnected - with a strong blow they are easily destroyed. Not necessarily, to violate the integrity of the eye socket, the blow must go into its area. In order for it to suffer, it is enough to seriously injure adjacent departments.

With such fractures, a concussion is guaranteed with one hundred percent probability. This is evidenced by many years of medical statistics.

According to the same statistics, fractures of the orbit alone are quite rare - just over 16 percent of those injured. This is the result of a precise direct blow to the eye area. Its main reason is fighting. Suffer (break), as a rule, the radial and lower bones. It is they who are the first to meet, flying to meet them, the fist of not a weak man. A woman cannot strike such a force. If will not use auxiliary resources. This is a matter of criminal medicine.

With such a strong blow, the eyeball also suffers. Sometimes such a patient cannot do without the help of ophthalmologists. This is where comprehensive help is needed. Two surgeons go to the operating room - an ophthalmologist and a traumatologist.

The lower wall of the orbit is not damaged by itself; the maxillary bone is also injured.

In 30% of cases of orbital fractures, they go in combination with neurotrauma. These patients, after the necessary medical examinations and manipulations, are transferred to the hands of neurosurgeons. Late treatment of such patients for help can lead to serious consequences. The cause of their appearance is post-traumatic deformities.

How are these fractures treated?

The goal of treatment for these fractures is to restore the orbital bone to its previous state (as far as possible). Also, medical measures are taken to regulate the position of the eye, restore its motor functions. If the fracture is not complicated, then the doctor may prescribe a conservative treatment for such a fracture.

Fracture of the lower wall of the orbit of the eyes is one of the most widely known types of injuries. The eye socket itself is a depression in the skull in which the eyeball is located. In accordance with statistical data, men in the age group from 20 to 40 years are more susceptible to ophthalmic fractures.

In most situations, a fracture of the orbital bone of the eye occurs due to trauma, impact, falls from a hill, traffic accidents, use of firearms, domestic and work injuries. The fracture itself appears as a result of a sudden increase in pressure indicators in the zone of the eye orbit. Orbital fractures are usually accompanied by injuries to the cheekbones, nose, frontal bone, etc.

Causes

You can get a fracture of the orbit of the eye due to:

Kinds

closed - are inside;
open - damage the skin.

According to the severity of the injury are divided into:

a fracture with a displacement (in this case, one cannot do without the help of a surgeon);
injuries without displacement;
cracks without fracture.

Symptoms

A doctor can help you heal your injury. The main thing is to find the problem behind the different symptoms.

The main symptoms of a fracture of the lower orbit of the eye:

Swelling of the area around the eye.
Weak mobility of the eyeball.
Diplopia - bifurcation of objects.
Enophthalmos - displacement of the eyeball into the orbit, or vice versa (exophthalmos).
Crunch in the lower part of the eye socket.
Severe pain in the eye area.
The presence of hematomas.

Diagnostics

X-ray - will allow you to consider the injury in more detail. This procedure will help determine the severity and location of the broken bone.
Magnetic resonance imaging - will determine the general condition of the orbit. After carrying out all the above procedures, the patient will be prescribed treatment, he will be referred to specialized doctors who will begin the treatment of the patient. A complex operation can also be prescribed, but this is only if, in addition to the orbit, other parts of the face are also damaged.

x-ray

X-ray of the eye orbits is one of the main methods for examining the eyeball and internal tissues. It helps to obtain an image using an x-ray machine. This method reveals:

tuberculosis and various diseases of the eye socket;
osteoma;
congenital anomaly.

This type of diagnosis is the best due to the fact that:

it is possible to identify various defects and recognize diseases of the early stages;
suitable for any age;
you can get a good picture to save to your computer;
is cheap.

To prescribe treatment, consult a doctor. He will make the correct diagnosis. There are other diagnostic methods:

Method 1. First, the doctor examines the condition of the injury, and then palpates. When making a diagnosis, he should talk about the symptoms. It is very important.

Method 2. An x-ray of the orbit must be taken continuously. With this method, you will see the state of the bone tissue.

Surgery

First, the patient needs first aid. It is required to treat the injury site, and then apply an antiseptic bandage. After that, in a short time, you need to call for medical help. In the event that the patient managed with a slight injury - a linear fracture, it can be treated conservatively. The patient should not be heavily loaded airways. This method can also be prescribed if surgery can cause complications due to excessive pressure on the orbit. If, on the contrary, the fracture is of high severity and is accompanied by deterioration or loss of vision, it is necessary to resort to surgical intervention. During orbital fracture surgery, the doctor will remove dead tissue and rebuild the bones. The types of operations are divided into 3 types:

early surgery - performed within 2 weeks after the fracture, is the most effective;
operation of the "gray period" - from 2 weeks to 4 months after the injury;
late surgery (osteotomy) - 4 months or more.

Rehabilitation

When the wall of the orbit of the eye is fractured, special attention should be paid to the rehabilitation period. The better it is, the faster healing will occur. Recovery in duration lasts from a couple of weeks to a month and a half. In the first two days, the patient is under the supervision of specialists in the hospital. For a quick recovery during the rehabilitation period and for the purposes of preventive measures, different drugs are used. During treatment, rehabilitation is required, the patient is prescribed medications (painkillers and anti-inflammatory drugs, a complex of vitamins and antibiotics) and physiotherapy.

Therapy with medicines

Includes medication:

Painkillers. For example, "Analgin".
Anti-inflammatory. You can also combine the first two properties and buy non-steroidal anti-inflammatory drugs (NSAIDs), which relieve pain and reduce inflammation. For example, "Nurofen", "Ibuprofen", "Ketorol", "Nise" and many others. Most of them can be bought with a prescription, but there are over-the-counter products that also work well.
antibiotics. Released strictly by prescription! Perhaps the doctor will prescribe drugs that help restore bone tissue. For example, "Mummy".
Vitamin-mineral complexes or drugs that strengthen the immune system (immunomodulators). It is also very important that the patient follow all the doctor's recommendations for a speedy recovery. He also provided himself with rest, ate healthy foods (vegetables, fruits) and limited eye strain.

1-10 days after the fracture - the body moves away from the injury;
10-45 days - primary callus is formed;
up to 3 months - complete formation of callus.

Consequences

The negative consequences of any injury, especially if it concerns, can lead to a disastrous outcome. The likelihood of severe consequences after an injury to the orbit of the orbit will directly depend on the nature of the injury, the promptness of emergency care, and the involvement of the optic nerve, blood vessels, and muscles of the eyeball in the process. Among the most common consequences of a fracture of the orbit of the eye (photo of the injury above) are:

Complications

A fracture of the orbit of the orbit can lead to the following complications:

Facial deformity.
Visual impairment.
Strabismus, diplopia.
Poor mobility of the eyeball.

Timely access to a doctor will reduce the risk of these complications. If you do not consult a doctor for a certain time, the patient's condition will worsen. In the absence of treatment, 2 weeks after the fracture, fibrous adhesions begin to form, the bone walls of the eye orbit begin to collapse. Scar tissue begins to form, due to which the deformation of the face occurs. After 3 months, the deformation is considered formed.

If treatment is not started on time, after the hematoma has formed, fibrin strands are deposited over time, and as a result, fibrous adhesions form. With which then it is necessary to struggle long and painfully.

These tips must be remembered:

Don't tilt your head back.
Place a swab in your nostrils to stop blood loss.
Apply something cold to reduce swelling.
Wash the wounds with a disinfectant solution ("Chlorhexidine"). Peroxide is useless in this case.

16.6. FRACTURES OF THE ORBIT

Orbit or eye socket(Fig. 16.6.1) - a paired recess in the skull, in which the eyeball with its auxiliary apparatus is located.

Rice. 16.6.1. Eye socket:

1 - frontal process of the maxillary bone;

2- lacrimal bone;

3- orbital plate of the ethmoid bone;

4- sphenoid bone;

5- orbital surface of the zygomatic bone;

6- orbital part of the frontal bone;

7- palatine bone;

8 - infraorbital foramen of the maxillary bone;

9- lower orbital fissure;

10- superior orbital fissure;

11 - visual aperture.

medial wall The orbit is formed by the frontal process of the maxillary bone, the lacrimal bone, the orbital plate of the ethmoid bone, and the body of the sphenoid bone anterior to the optic canal. Lateral wall consists of the orbital surface of the zygomatic bone and the large wings of the sphenoid bone. Top wall formed by the orbital part of the frontal bone and the lesser wings of the sphenoid bone. Bottom wall (bottom) - the zygomatic bone and the upper jaw, and in the posterior part - the orbital surface of the process of the same name of the palatine bone.

In the upper outer corner of the orbit there is a recess for the lacrimal gland, and on the inner third of its upper edge there is a supraorbital notch for the vessels and nerves of the same name. Through the superior orbital fissure, the first branch of the trigeminal nerve enters the orbit, the oculomotor, abducens, and trochlear nerves and exits the superior ophthalmic vein. The symptomatology associated with damage in this area is called syndrome of the upper orbital fissure. The optic nerve and ophthalmic artery pass through the optic canal. The infraorbital and zygomatic nerves enter the orbit through the inferior orbital fissure, and the inferior ophthalmic vein exits. The walls of the orbit are covered with periosteum, which is closely fused with the bone skeleton only along its edge and in the region of the optic opening, where it is woven into the sheath of the optic nerve.

In children, the rudiments of molars are close to the lower edge of the orbit. By 8-10 years, the shape and size of the orbit are almost the same as in adults.

Four rectus and two oblique muscles provide the necessary mobility of the eyes in all directions: outward (abduction)- due to the lateral rectus, lower and upper oblique muscles; inside (adduction) - medial rectus, superior and inferior rectus muscles; up - the upper straight and lower oblique muscles; down - the lower straight and upper oblique muscles.

Orbital fractures, depending on the mechanism of injury, are varied, but the most common damage to the lower wall is due to fractures of the zygomatic bone and upper jaw of type II or III. With the latter, the inner wall of the orbit is also damaged. Due to the formation of hematomas in the retrobulbar space develops exophthalmos or superior orbital fissure syndrome- ophthalmoplegia (paralysis of the muscles of the eye), ptosis (drooping of the upper eyelid), lack of sensitivity of the upper eyelid and forehead skin, expansion and fixed position of the pupil. There is diplopia, decreased vision. There are fractures of the upper and lower orbital margins.

Treatment orbital fractures is to restore the anatomical integrity of the bone fragments of the zygomatic or maxillary bones. In case of isolated fractures of the upper or lower orbital margin, a skin incision is made along the corresponding margin of the orbit, a revision of the fracture gap is made, the interposed soft tissues are released, repositioned and fixed to the intact bone areas of the orbit using titanium miniplates or chrome-plated catgut.

Comminuted fractures of the inferior wall of the orbit are treated by tight tamponade with an iodoform tampon of the maxillary sinus and restoration of the inferior wall of the orbit. The end of the tampon is removed through a pre-made fistula into the lower nasal passage (rhinostomy). The postoperative wound is sutured. The iodoform tampon is kept in the maxillary sinus for about 14 days.

In case of bone defects of the lower wall of the orbit, it is necessary to perform plasty with autobone or alloplastic materials (titanium, teflon, silicone, etc.).

Given the fact that all damage to the orbit is accompanied by a closed injury (contusion) of the eyeball (bruise, concussion, compression), patients should be treated together with an ophthalmologist.