PMC8697045_01
CT scans at the initial presentation showing. (a) Axial scan with lateral and medial wall fracture. (b) Coronal scan with floor and medial wall fractures.
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F1
CT scans had shown extensive fracture of both ethmoid and maxillary sinus walls, right orbital medial and inferior wall, with bony fragments dislocation, fat prolapse, and hemorrhagic content in the right maxillary sinus (Fig. 1a, b).
The clinical examination performed seven months after the initial surgery showing the (a) hypoblobus and enophthalmos, (b) right eye, (c) left eye (d) CT coronal scan with the floor and medial wall fracture.
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F2
There were relative hypoglobus and enophthalmos on the injured right side, with hypoglobus of 5 mm and enophthalmos of 4 mm by Hertel exophthalmometry (right eye 13 mm and left eye 17 mm) (Fig. 2a-C). Both globes and other orbital structures were of regular form and size, with the right globe clearly enophthalmic on the scan (Fig. 2d).
Surgical management via (a) Transconjunctival approach, (b) and (c) exposure of the orbital floor.
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F3
A traction suture was placed to elevate the conjunctiva and retractors over the cornea, using 6-0 nylon suture (Fig. 3a). Herniating orbital tissue was reduced from the fracture back into the orbital space (Fig. 3b, c).
Patient at 14 weeks follow-up with improved (a) hypoglobus and enophthalmos (b) CT scan at 14 weeks follow up.
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F4
At 1-week follow-up, the relative enophthalmos improved from 4 mm to 2 mm, hypoglobus was minimal (Fig. 4a, b), and no RAPD was shown.