Fig. 6.37  Combination of medial and inferior blow-out fracture of the orbit. Only slight displacement of the medial orbital wall into the ethmoid and moderate displacement of the medial part of the

Fig. 6.38  Rare situation of a blow-out fracture of the orbital roof. Displacement of the fragment into the right frontal sinus (arrow). Hematoma along the superior rectus muscle and within the frontal sinus (arrow)

inferior orbital wall into the maxillary sinus (arrow). The sagittal CT image demonstrates swelling and displacement of the inferior rectus muscle over the edge of the orbital floor fracture (arrow)

6.3.3.4  Multiple Wall Fractures

In complex facial trauma, multiple orbital wall fractures may lead to severely disturbed eye motility, neurological syndromes (e.g., OAS), and optical nerve injuries.

In orbital roof fractures, additional liquorrhea, pneumocephalus, or epidural hemorrhage is often found (Fig. 6.40).

Additional extraorbital injuries in orbital roof fractures

•Epidural hematoma

•Pneumocephalus

•Liquorrhea

•Fatty tissue prolapse into the frontal sinus

Fig. 6.39  Upper row: Comminuted fracture of orbital roof, sphenoid wing and cribriform plate (arrow) with consecutive disturbed motility (restriction: superior oblique and rectus muscles).

Lower row: Clinical presentation: enophthalmus, ptosis, and depression of the globe