Photo Rounds

Indirect blow-out fracture of the Orbital Floor

X-ray

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An indirect blow-out fracture occurs when the force is directed to the infraorbital rim causing the orbital floor to buckle. This mechanism is more likely to cause injury to the infraorbital nerve than the direct mechanism. The inadequate Water's view x-ray of the sinuses (the head should be tilted to a degree so that the petrous ridges do not obscure the maxillary sinuses) demonstrates an accumulation of blood in the right maxillary sinus suggestive of a blow out fracture of the orbital floor. The coronal computed tomography scan of the orbits demonstrates blood in the right maxillary sinus as well as orbital contents extruding through the orbital floor. (L.S.)