Isolated Orbital Roof Fracture: Can It Be Catastrophic?

Abstract

Orbital encephalocele is a rare catastrophic complication of orbital roof fractures. Early diagnosis of this posttraumatic orbital encephalocele is very crucial because this condition if untreated leads to rapid loss of vision. Whenever displaced orbital roof fracture is identified in a head injury patient, an orbital encephalocele should be suspected. Although magnetic resonance imaging is the investigation of choice, computed tomography of orbit with thin axial and coronal sequences often gives the diagnosis. Frontobasal approach is the most commonly used surgical approach. Supra-transorbital approach is a minimally invasive alternative. Good results with regard to the orbital symptoms can be expected.

Keywords: Frontobasal approach; intraocular pressure; orbital encephalocele; supra-transorbital approach.

Figure 1

Computed tomography scan of the head done on admission showed suspected extraconal hematoma. Note the periorbital soft-tissue swelling

Figure 2

(a) Note the proptosis of the right eye. (b) Axial computed tomography head shows extra-axial mass displacing the eyeball. (c) Coronal section of computed tomography orbit shows brain parenchyma herniating into the orbit. (d) Coronal bone window shows the displaced orbital roof fracture

Figure 3

(a) Postoperative picture shows the complete resolution of proptosis. (b) Three-dimensional reconstruction of computed tomography skull shows orbital roof reconstruct. (c) Coronal computed tomography orbit shows the titanium mesh covering the orbital roof defect