Ist eine Rehabilitation nach einer kompletten Bulbusluxation in die Kieferhöhle bei Orbitabodenfraktur möglich

BACKGROUND: The complete traumatic dislocation of the globe into the maxillary sinus after orbital floor fractures is a very rare event. It results from direct transmission of a traumatic force which impinges the orbital frame or may result from an increasing pressure to the orbital contents. Diplopia or evidence of a displaced globe necessitates an exploration and reconstruction of the orbital floor. CASE REPORT: A 62-year-old male was admitted to our hospital because of a blunt injury to the orbital region caused by a machine for planing timber. On examination the patient had a massive right periorbital haematoma and no globe was visibly found. The CT scan revealed a blow-out fracture of the orbital floor with a complete dislocation of the right globe into the right maxillary sinus. Using a bright flashlight on the right maxillary region the patient reported light perception. The operative exploration showed no impaired integrity of the globe, no apparent laceration of the orbital muscles and a preserved continuity of the optic nerve. The dislocated globe was repositioned manually into the orbit and secured by an antral balloon catheter. CLINICAL COURSE: Postoperative magnetic resonance imaging showed a correct anatomic status. The muscles did not seem to be lacerated and the continuity of the optic nerve was demonstrated. Incarcerations were not existent. 9 months postoperatively the vision recovered to 1.0 p. The motility was slightly diminished (elevation and abduction 20 degrees, adduction 25 degrees and downwards 20 degrees over midline). The patient suffered from diplopia when looking 25 degrees to the right and 20 degrees upwards. The anisocoria with a slight dilation of the pupil had declined in the right eye but was still present. CONCLUSION: This case of complete dislocation of the globe into the maxillary sinus demonstrates that only few injuries may result and that after operative reconstruction of the orbital floor a good functional result can achieved.