Orbital Fractures

Orbital Blowout Fracture:

• Involves medial and inferior walls
• Need to check visual acuity and sensation, extraocular movements
• Higher risk of ocular injury compared to non-pure orbital fractures (because in non-pure, orbital rim is involved, meaning the rim is taking some of the impact, vs. pure blowout, the eyeball itself is taking most of the impact, causing the wall/floor fractures)
• Always evaluate for retrobulbar hematoma!! Evaluate for proptosis, decreased visual acuity, elevated intraocular pressure (concerned if >40mmHg), afferent pupillary defect
• *Management = lateral canthotomy

Entrapment: Limitation of upward gaze from entrapment of inferior rectus muscle, binocular diplopia (vs monocular diplopia suggests lens dislocation); can have infraorbital anesthesia.

Management of Orbital Fractures:

• PO amox-clav (Augmentin) to treat sinus pathogens
• Decongestants
• Avoid nose blowing
• Facial consult before discharge 

Naso-orbito-ethmoid fractures: Usually require admission and facial surgery, sometimes neurosurgery consult because they are often accompanied by injury to lacrimal duct, dural tears, and traumatic brain injury

Tripod fracture: Zygomaticomaxillary tripod fracture (malar flattening of cheek)

• Zygomatic arch
• Maxilla (including sinuses)
• Lateral orbit

LeFort Fractures:

Mandibular Fractures:

• Management: All except isolated coronoid fracture will need repair, but not necessarily emergent
• Closed fracture: nondisplaced; soft/liquid diet with urgent outpatient follow up
• Open fractures: emergent consult, antibiotics (penicillin G, clindamycin), admit