Abstract
Traumatic optic neuropathy is a relatively rare complication of midface trauma, with 20％ of cases associated with optic nerve canal fractures. We report a case of concurrent midfacial and optic nerve canal fracture. The patient was a 60-year-old man who suffered systemic pan-traumatic injuries caused by falling from a stepladder. On examination, the patient was conscious, vital signs were stable, and there were no abnormal neurological findings. A computed tomography （CT） scan revealed a left naso-orbito-ethmoidal Type I fracture, left zygomatic and maxillary complex fractures, anterior and middle skull base fractures, together with an optic nerve canal fracture. Since there was no loss of vision, the anterior and middle skull base fractures and optic nerve canal fracture were first treated conservatively. However, traumatic optic neuropathy due to optic nerve canal fracture developed on the 5th day; therefore, endoscopic optic nerve decompression was immediately performed with navigation and endoscope assistance on the 7th day. In addition, steroid pulse therapy was administered for 3 days starting the day after the surgery. On the 15th day, open reduction and internal fixation of the midfacial fractures was performed. Currently, 18 months since the surgery, his vision has been restored and the midfacial trauma treatment is progressing well. In cases of maxillofacial trauma with suspected optic canal fracture, prompt and appropriate examination, diagnosis, and treatment of traumatic optic neuropathy is desirable.
