Medial orbital wall fracture accompanying orbital emphysema can induce supraduction limitation like inferior wall fracture and inferior rectus entrapment

Mijung Chi

Purpose: We report 5 cases of temporary restriction of supraduction in patients with medial wall fracture with orbital emphysema that can be misunderstood for inferior rectus muscle entrapment

Methods: The cause of accident was a heavy blow by beating or sports injury and each experienced sudden inflation of upper lid followed by vigorous nose blow. There were severe upper lid swelling, crepitus at palpation, limitation of supraduction and mild hypotropia at primary gaze. They did not complained nausea, vomiting and pain on extraocular movements. In 3 cases, mild proptosis of 0.5 ~ 1.0mm presented

Results: A CT scan revealed linear or hinged fracture of medial wall but no floor fracture. Subcutaneous emphysema was noted, and extraconal air trapped at superior portion of orbit which led to inferior displacement of the muscle cone. Patients were reviewed at 1 ~ 4 days after the trauma with full resolution of eye movements with no diplopia and crepitus.

Conclusions: Although the orbital contusion with supraduction restriction could be a doubtable inferior wall fracture and inferior rectus muscle entrapment, we should confirm the existence of upper eyelid crepitus by palpitation and medial wall fracture accompanying orbital emphysema by CT scan. If the CT scan reveal superior orbital emphysema and that is thought to be the cause of supraduction limitation and diplopia, we can anticipate the resolution of the symptoms with short term observation.