Inferior rectus entrapment in a medial orbital wall fracture: A case report

Abstract

Orbital fractures are typically caused by blunt periocular trauma and are one of the most common types of facial fractures. The most common entrapment is that of the inferior rectus muscle in a fractured floor. However, we present a unique case of an inferior rectus muscle entrapment in a medial orbital wall fracture.

Highlights

  • There are no published reports of an inferior rectus entrapment in a medial orbital wall fracture.

  • We present a case of a patient with an nferior rectus entrapment in a medial orbital wall fracture.

  • The patient underwent urgent surgical intervention and ultimately recovered without any residual effects.

  • We believe that urgent diagnosis and surgical intervention is imperative for patients to recover without sequela.

Orbital fractures are typically caused by blunt periocular trauma and are one of the most common types of facial fractures [ ]. An important complication of orbital fractures is entrapment of extraocular muscles and orbital fat in a trapdoor fracture. This occurs most commonly in the pediatric population, as their bones are more pliable and elastic [ ]. In a trapdoor fracture, the bone is fractured on one side but remains intact on the other which can entrap orbital fat and muscle in the fracture site. Most often the inferior rectus and medial rectus muscles can be involved.

The inferior rectus originates from the lower tendon of Zinn and parallels the orbital floor. It passes through a connective tissue pulley and follows the curve of the globe to insert inferior to the limbus [ ]. The inferior rectus depresses and adducts the eye. If the inferior rectus were to become entrapped, patients often present with vertical gaze diplopia and restriction of upgaze [ ]. The medial rectus originates from both the upper and lower tendon of Zinn and parallels the medial orbital wall. It also passes through a pulley and then follows the curve of the globe to insert medial to the limbus [ ]. The function of the medial rectus is to adduct the eye. Entrapment of the medial rectus tethers the globe and prevents lateral gaze, resulting in horizontal diplopia.

The most common entrapment is that of the inferior rectus muscle in a fractured floor. We present a unique case of an inferior rectus muscle entrapment in a medial orbital wall fracture.

Case presentation

A 69-year-old female was involved in a motor vehicle collision at highway speeds. Upon arrival to the Emergency Department (ED), she was complaining of a headache, double vision, and nausea. Physical exam was significant for severe edema of the left eyelids requiring manual distraction to open the palpebral fissure. Upon opening the fissure, there was only white sclera visible as the pupil was restricted in a caudal and medial direction (down and in), which is demonstrated in Fig. 1 . The patient had significant restriction of superior gaze ( Fig. 2 ) and lateral gaze of the left eye. She also had diplopia on gross visual examination and severe nausea and vomiting refractory to anti-nausea medication.

Fig. 1
Photograph demonstrating left eye restriction in a caudal and medial direction.

Aug 8, 2020 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Inferior rectus entrapment in a medial orbital wall fracture: A case report
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