FOAMed Question of the day 9 #FOAMedQOTD

What abnormality is shown on this x-ray? What examination signs may also be present?

Bonus point question: Which All Black had this injury?

orbital floor

Answer

Comments

  1. Blowout fracture right orbital floor. Loss of up gaze on right
    Cool X-ray – can actually see the blend of rectus in the fracture
    C

  2. Malin Zachau says:

    Orbital blow out fracture of Right eye.

    Restricted vertical movement of eye, loss of sensation of upper cheek area

    Sitiveni Sivivatu against the Wallabies in August 2011.

  3. Chee Yong Chuan says:

    Waters view showing classic “tear drop sign” representing herniated orbital contents into the ipsilateral maxillary sinus. Air fluid level is also seen in the right maxillary antrum likely to be due to collection of blood. The above is consistent with right sided orbital wall fracture(blow out fracture)

    The inferior rectus is one of the most common nerve to be entrapped, giving rise to diplopia particularly on upward gaze. You may also find enopthalmos, due to reduction of orbital content, ecchymosis, periorbital emphysema due to direct connection with air filled sinuses. The infraorbital nerve also runs along the orbital fall, if entrapped will result in hypoesthesia involving the ipsilateral cheek, lip and gingiva

    Football/footie/rugby is not a popular sport in my part of the world, sorry couldn’t help with that question!

  4. chee Yong Chuan says:

    Since it was a bonus point question. Thought of giving it a quick “google”,Sitiveni Sivivatu??

  5. Victoria Stephen says:

    My best guess without correlating clinically is:

    Fractured right floor of orbit, blood (air-fluid level) in right maxillary sinus.
    Findings include: surgical emphysema over inferior aspect orbit, peri orbital haematoma, decreased sensation over cheek due to inferior orbital nerve injury, ophthalmoplegia due to inferior rectus entrapment, can’t look down.
    As for which All Black player- won’t even attempt that one!

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