Intraoral examination revealed no other injuries, and the occlusion was unaltered. There was mild hypoesthesia of the infraorbital nerve (i.e., the V2 distribution of CN V), but no other CN deficits were detected. The patient’s visual acuity–while wearing his glasses–was 20/20 in the right eye (ocular dextra ) and 20/30 in the left eye (ocular sinistra ), which was consistent with his baseline. There was no relative afferent pupillary defect (RAPD), which suggested preservation of the autonomic innervation of the eye (i.e., parasympathetic nerves traveling along cranial nerve III, and sympathetic nerves traveling along the ophthalmic nerve ). The pupils were round, briskly reactive, and measured 3-mm bilaterally. No lagophthalmos (inability to completely close the eyelids), proptosis (anteroposterior protrusion of the globe), or severe pain in the left eye was detected. No enophthalmos (anteroposterior retrusion of the globe) could be appreciated but there was mild hypoglobus (vertical depression of the globe). There was mild binocular diplopia on upward gaze, but there was no diplopia in primary gaze, monocular diplopia, or ophthalmoplegia (impaired extraocular movements). Palpation of the facial bones revealed no overt step deformities or point tenderness. Head and neck examination revealed left-sided periorbital ecchymosis and subconjunctival hemorrhage (Fig. All vital signs were stable and the patient was afebrile. On presentation to the ED, the patient was awake, alert, and oriented to person, place, and time. Due to persistent pain and double vision (diplopia) on upward gaze in the affected eye, the patient sought medical attention. The patient was involved in an altercation four days prior, during which he received a blow directly to the left eye. Timely, evidence-based management of orbital and ocular trauma will prevent many, if not all, long-term disabilities and/or deformities.ĭescribed herein are cases of orbital trauma referred to, and managed by, the Oral and Maxillofacial (OMF) Surgery service at London Health Sciences Centre in London, Ontario, Canada.Ī healthy 56-year-old man was referred to the OMF Surgery service for assessment and management of a left-sided orbital floor fracture. Of particular importance are fractures of the orbit, where delicate nerves and muscles may become entrapped between bone fragments, or compressed by hematoma or edema, leading to ischemia and potentially permanent disability. While a computed tomography (CT) scan helps to visualize even the most inconspicuous of facial fractures, a thorough head and neck examination will often reveal such injuries before imaging has been performed. Whether the assessment occurs in the ED, the hospital ward, or the private dental clinic, a full examination of the oral and maxillofacial structures is required to identify all facial injuries. General dentists and dental specialists alike are often called upon by Emergency Department (ED) physicians to assess patients with dental injuries and concomitant maxillofacial trauma.
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