30 years old patient came with h/o injury while playing cricket.
Swelling of right eye +
Diplopia +
Bleeding from right nose +
No h/o loss of consciousness / vomiting
On examination:
Swelling over upper and lower eyelids on the right side +
Enophthalmos +
Ocular movements mildly restricted on medial gaze
Diplopia +
Forced duction test +
Clots seen in the right nasal cavity
Patient has tendency of keloid formation
Clinical photograph of the patient
CT scan plain para nasal sinuses was taken. It showed blow out fracture of inferior wall of right orbit with prolapse of orbital contents. The prolapsed orbital contents resembles a tear drop hence the name "tear drop sign".
CT scan paranasal sinuses showing blow out fracture and the classical tear drop sign
Since this patient has keloid forming tendency, facial incision was avoided.
Reduction was performed via Caldwel Luc procedure under endoscopic guidance.
The fractured fragment was reduced and stabilized using foleys catheter which was inserted into the
maxillary sinus cavity via inferior meatal antrostomy.
Picture showing sublabial incision for caldwel luc surgery
Blow out fracture is seen being reduced via the opening made over the canine fossa area under endoscopic guidance.
Foley's catheter was introduced into the maxillary antrum via inferior meatal antrostomy.
Foley's catheter seen inside the antrum
Balloon of foley's catheter seen inflated inside the antrum
Discussion:
Since this patient had a tendency for keloid formation, this approach was preferred. It has also the unique advantage of avoiding facial incision.
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