Question:

Surgical intervention of orbital roof fracture is likely in all the following circumstances, except:
1. CT and clinical evidence of extraocular muscle entrapment.
2. CT evidence of optic nerve impingement and decreasing vision.
3. Clinically asymptomatic isolated orbital roof "blow in" fracture.
4. CT evidence of retrobulbar hemorrhage and decreasing vision.
5. Significant cosmetic abnormality identified clinically.





Answer:

The correct answer for the question "Surgical intervention of orbital roof fracture is likely in all the following circumstances, except:" is:

3. Clinically asymptomatic isolated orbital roof "blow in" fracture.



Explanation

a. CT and clinical evidence of extraocular muscle entrapment. (Surgery is often performed if significant neurological, ophthalmologic, or aesthetic deficiency is clinically apparent or expected to eventually result from the injury and the surgical intervention is likely to improve clinical outcomes.)

b. CT evidence of optic nerve impingement and decreasing vision. (Surgery is often performed if significant neurological, ophthalmologic, or aesthetic deficiency is clinically apparent or expected to eventually result from the injury and the surgical intervention is likely to improve clinical outcomes.)

c. Clinically asymptomatic isolated orbital roof "blow in" fracture. (Pure "blow-in" fractures, "blow-out" fractures, and non-displaced fractures that are asymptomatic generally have minimal clinical consequences and can be managed conservatively without surgery.)

d. CT evidence of retrobulbar hemorrhage and decreasing vision. (Surgery is often performed if significant neurological, ophthalmologic, or aesthetic deficiency is clinically apparent or expected to eventually result from the injury and the surgical intervention is likely to improve clinical outcomes.)

e. Significant cosmetic abnormality identified clinically. (Surgery is often performed if significant neurological, ophthalmologic, or aesthetic deficiency is clinically apparent or expected to eventually result from the injury and the surgical intervention is likely to improve clinical outcomes.)



From the manuscript:
Orbital Roof "Blow-in" Fracture: A Case Report and Review
Radiology Case. 2009 Dec; 3(12):25-30


This article belongs to the Neuro section.




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From the manuscript

Orbital Roof "Blow-in" Fracture: A Case Report and Review

Free full text article: Orbital Roof

Abstract
We report a relatively rare case of an essentially isolated orbital roof "blow-in" fracture in a pediatric patient. A 13-year-old male presented with headache and nausea following blunt facial trauma sustained during a skate boarding accident. CT head revealed soft tissue swelling and an abnormal bony density in the superior, posterior right orbital region. Follow-up CT orbits revealed a comminuted orbital roof "blow-in" fracture with involvement of the ethmoid air cells and two tiny foci of intracranial air. Expert consultation revealed normal ophthalmologic and neurologic examination; conservative management was recommended. The case report is followed by a brief overview of orbital fractures including pertinent radiographic considerations.






References



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