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Information on blow-out fracture - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2572 Questions
User :   need info on blow out fracture
Doctor :   hi
Doctor : here.
User :   hi i wonder if you can help.
User :   I had a blunt trauma blow out fracture 18 months ago.
User :   right eye orbital floor.
User :   i had diplopia and entrappment of the inferior rectus muscle
User :   the fracture was surgically repaired and the muscle released
Doctor :   ok. what would you like to know about it?
User :   i have constant pain and need to take pain killers everyday
User :   i had another ct yesterday 8 they never took one at any of the out patient controls9 and the results show displacement of the earlier entrapped muscle, and that the inserted plate has sunken 7 mm
User :   i still have diplopia when looking upwards, downwards and to the outside
Doctor :   the slipping of the plate could be one of the reasons for continued diplopia and your pain
User :   The results suggest that the muscle is still trapped which would account for the double vision, but is it normal that the repair becomes " recessed" into the sinus or should this be flat ?
Doctor :   did you follow up with your treating doctor with the recent MRI?
User :   The Dr that treateed me nevertook follow up pictures. i had a CT of the sinus and orbits yesterday and the GP phoned me late last night. i am awaiting an appointment with a specialist
User :   Surely normal practce is to take follow up pictures if the patient complains of pain and diplopia over a year after the initial surgery?
Doctor :   ok. you will need repeat appointment with a surgeon specializing in head and neck surgery. the symptom correction and relief will depend on the angle of fracture and degree of entrapment
Doctor :   follow up should be every 15 days in initial period until you are symptom frees.
Doctor :   if symptoms are recurring then intervention might be needed again to correct them
User :   i was told by the drs that they could not understand why i still had diplopia and that the start position of the eye was normal and thats it.
User :   I am interested in knowing if the recessing / siniing of the plate is normal ( expected) and if not what further options for treatment there are.
Doctor :   the alignment of the bones has to be normal or near normal as well the associated fibrosis and bleeding within the orbit after injury could be the cause of the persisting entrapment and diplopia
User :   they discharged me in march and after the last 6 months of taing pain killers i had enough
Doctor :   if the plate has been fixed surgically by screws then the chances of recessing or sinking are minimal
User :   as i understand it , there was so much damage to the orbital floor that most was removed and a silicone/synthetic plate was inserted instead.,
User :   not by screws as far as i understand. the recessing/siniking is measured at 7 mm
Doctor :   the possibility of muscles and tendons undergoing fibrosis and resulting shortening could be the cause of the present dipplopia
Doctor :   more than 5mm shift can have pressure effects causing pain to persist
User :   what do you mean by muscles and tendons undergoing fibrosis
User :   and what is the treatment?
Doctor :   the eyeball is fixed by 7-8 muscles which are very small to control movements
Doctor :   any changes in them can affect the vision
Doctor :   with injury, changes like fibrosis (comonly seen as scars when skin is injured) can occur
User :   and is this a normal " side effect"?
Doctor :   resulting in the symptoms that you are faced with
User :   this would show on an MRI i take it and not on the CT
Doctor :   yes. this is side effect of surgery or trauma
Doctor :   yes. MRI can delineate tissues more clearly and show minute details of small scars
User :   is it treatable or am i going to be on pain kilers for ever. it has a massive affect on life generally.?
Doctor :   the treatment lies in selective correction of the underlying defect by an experienced orbital surgeon.
User :   So basically i am looking at a surgical solution to this?
Doctor :   yes, for permanent relief, it would be best option.
Doctor :   was there any neurological involvement or symptoms after injury?
User :   yes the major nerve from my eye to my lip was destroyed.
User :   i still have highly reduced sensitivity here.
User :   my nose is numb( right side)
User :   what would the surgery involve other than replacement of the plate?
Doctor :   ok. probably this could be also one of the cause for dipplopia
Doctor :   as few fibres of muscles do get supplied by this nerve
User :   ok
Doctor :   called ophthalmic branch of the Trigeminal or Facial nerve
Doctor :   no, it may not involve another plate, or replacement until the plate is found to be damaged.
Doctor :   a Neurological consultation and evaluation will also help
User :   so the recess/sinking may not need to be rectified?
Doctor :   in seeing is pain in neurological in origin
Doctor :   and treatment to control pain would differ than giving usual pain killers
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