안와골절의 진단과 치료

Diagnosis and Management of Orbital Wall Fracture

Blunt trauma to the orbit commonly results in fracture of the medial wall and the floor of the orbit due to the thin nature of the bones. Fracture of the orbital floor may arise from the force caused by posterior globe displacement during blunt trauma and increased orbital pressure (hydraulic theory) and/or from direct trauma to the inferior orbital rim causing the floor to buckle (rim buckling theory). Although computed tomography is the most effective tool for orbital wall fracture diagnosis, it is important for the correct diagnosis that the symptoms and signs such as nausea, vomiting and extraocular movement should be evaluated because trapdoor type of fracture is common in children. Early surgical correction within 2 weeks may prefer because of easier reposition of herniated orbital contents. Dissection to the posterior margin of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos and scarring with recurrent diplopia. Demonstration of slight exophthalmos of the corrected side by about 1-2 mm at the end of the operation is also necessary because absolute deficiency and a temporary exophthalmic effect due to surgical trauma have to be considered.