Trauma in Otolaryngology by Jayita Das

Author:Jayita Das
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

2. The middle third composed of the nose, eyes, naso-orbito-ethmoid (NOE) complex, the two maxillae and zygomatic bones, and the palate.

On clinical examination, facial asymmetry is evident if proptosis (increase in the vertical dimension) or enophthalmos (decrease in the anteroposterior dimension) is present. Though this is usually seen on direct examination, an indirect evidence of the same is provided if the upper lid crease is increased (deepened) or there is an increase in the length of the upper lid. The presence of enophthalmos can also be detected by applanation tonometry, which would reveal a pressure difference of more than 4 mm Hg. The forced duction test is also a useful clinical method to determine mobility of the globe and entrapment of intraocular muscle in an orbital blowout fracture. To do this, the conjunctiva must first be anesthetized using a topical agent, and then the globe can be moved in all directions and restriction of movement observed in the direction of involved muscle. The medial canthus of the eye can be grasped, at the point of its attachment on the sclera, between forceps to judge firmness or loss of elasticity, which would suggest avulsion of the medial canthus from its attachment. Though it is rare for the medial canthus to be completely avulsed or detached, the more common occurrence is that it exerts traction on its bony attachment, which in turn is gradually displaced from its normal position, thus changing the final resting position of the globe. A negative forced duction test also helps to differentiate entrapment of the medial rectus muscle from ophthalmoplegia. In the latter, the globe can be passively moved while this is not possible in case of muscle entrapment.

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