1991 Volume 94 Issue 12 Pages 1816-1825
Twenty-one cases of isolated medial orbital wall fractures were reported and CT findings by coronal planes were evaluated as to the effects of fractures upon the ethmoidal cells and nasal meati. Three coronal planes, which respectively contain such structures as Agger nasi, Pars membranacea and superior meatus, were selected for the study. The extent of fracture was evaluated by dividing the medial wall into three equal portions, i.e., superior, middle and inferior. The prolapsed volume was evaluated in three classes of occupying 1/3, 2/3 and 3/3 of the ethmoid. The presence of soft tissue density was recorded at the three surfaces, upper, medial and lower, around the prolapsed orbital content. The extent of the fracture was most often seen in such cases as involving all the three divisions in 41. 3%. The prolapsed volume occupying 1/3 was seen in 28. 6%, and 2/3 in 23. 8%. The presence of soft tissue density was seen in 38. 1% of upper surface, in 36. 5% of medial, and 11. 1% of lower. Summarizing the total effects of the fractures, the coronal plane containing Pars membranacea was most severely damaged followed by the plane of the superior meatus. Two rare cases of fronto-ethmoidal mucoceles, caused by the traumas of 23 and 14 years before respectively, were also included and reported. The ophthalmological prognosis was favorable in 90. 5% of cases by observations extending more than 6 months. Five cases were surgically treated including two cases of mucoceles. It follows from the present study that the main stay in the treatment for the medial orbital wall fracture is conservative and selective indications for the surgery is the persistent and annoying diplopia in spite of about two weeks' observations.
