[Orbital involvement in frontobasal injuries]

Abstract

In the mechanism of fracturing in the region of the frontobasis and of the midface there is the possibility of an orbital involvement. If the traumatic forces affect directly the frontal zone we may find a latero-orbitalfrontobasilar fracture--the socalled type IV according to the classification of frontobasilar fractures by Escher. If the middle face is more affected, the type III will result with tearing off the midface bones from the skull at the frontobasis. In a few cases there are indirect blow-out fractures of the orbital roof in communication with frontobasilar fractures especially in the ethmoidal or frontal sinus region. Penetration of foreign bodies through the orbital roof and through the lamina cribriformis cause an open frontobasal cerebral trauma. The problem of the penetrating fronto-orbital traumata is to find the foreign body and to remove it. The danger is the infection with possible development of meningitis or brain abscess. The quota of lesions of the optic nerve in frontobasilar fractures seems to be relatively high. The pathogenesis of optic nerve injury is rather unknown. Mechanisms to be considered are discussed as well as indications and contraindications for a rhinosurgical decompression operation in the optic canal.