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New Muscle Entrapment After Facial Fracture Repair
Katherine E Duncan, MD; Jonathan Y Lee, MD, MPH; S. Tonya Stefko, MD; Joseph E Losee, MD; Jesse A Goldstein, MD
University of Pittsburgh Medical Center
2017-02-14
Presenter: Katherine E Duncan, MD
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Despite controversy regarding the indications and timing of orbital fracture repair, extraocular muscle entrapment is a clear indication for early surgical intervention. Entrapment typically presents with limitation in extraocular movement, pain, nausea and bradycardia immediately after injury. Very few cases of new extraocular muscle entrapment after surgery have been reported in the literature.
Case Presentation
We report a case of a 15-year-old male who developed entrapment of the inferior rectus after repair of frontal sinus and orbital roof fractures. Ophthalmologic evaluation at presentation revealed decreased vision in the left eye, hyphema, and mild limitation in upgaze. Imaging at presentation was significant for a comminuted depressed fracture of the left frontal bone as well as a mildly displaced left orbital floor fracture without entrapment. The patient was taken to the OR for repair of his frontal bone and orbital roof fractures. Post-operative ophthalmologic exam revealed a new complete limitation in upgaze with positive forced duction testing. Post-operative imaging showed increased displacement of the orbital floor fracture with herniation of the orbital fat and entrapment of the inferior rectus muscle.
Results
The patient was immediately taken back to the OR for release of the entrapped muscle and orbital floor fracture repair. Forced ductions were normal at the end of the case. Ocular motility returned to normal within 1 week.
Conclusion
Extraocular muscle entrapment can occur with surgical manipulation of the orbit. Reflection of the coronal flap can place pressure on the periorbit to exacerbate orbital wall fractures, potentially resulting in entrapment.
