Fraktura dna orbite

master's thesis

• Title (english): Blow out fractures
• Author: Klara Puzak
• Mentor: Jelena Juri Mandić (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Committee member: Jelena Juri Mandić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Frakture dna orbite su prekid kontinuiteta orbitalnog dna s nezahvaćenim orbitalnim rubom. Nastaju kao posljedica direktnog udarca usmjerenog prema infraorbitalnom rubu ili samom orbitalnom sadržaju. Dvije su teorije koje objašnjavaju mehanizam nastanka fraktura dna orbite. Prva, hidraulična hipoteza govori o djelovanju sile na područje orbite pri čemu dolazi do privremenog povećanja intraorbitalnog tlaka te posljedične frakture kosti i prolapsu intraorbitalnog sadržaja kroz koštani defekt u maksilarni sinus. Druga teorija pretpostavlja savijanje kosti zbog direktnog djelovanja sile na infraorbitalni rub kao mogući uzrok frakture. Međutim, u patogenezi frakture dna orbite sudjeluju oba mehanizma, pri čemu svaki od njih dovodi do različitog kliničkog i radiološkog nalaza. Klinička prezentacija uključuje diplopiju pri pogledu prema gore, enoftalmos, hipoesteziju u inervacijskom području maksilarne grane V. kranijalnog živca te ekhimozu i edem periorbitalno. MSCT je zlatni standard u dijagnostici fraktura dna orbite jer pruža brzu i detaljnu informaciju o lokalizaciji i veličini frakture te mogućoj hernijaciji orbitalnog tkiva kroz koštani defekt. Indikacije za hitnu kiruršku intervenciju su „white-eyed“ fraktura dna orbite kod djece i okulokardijalni refleks nastali kao posljedica uklješenja mišića unutar frakture i retrobulbarni hematom. Enoftalmos veći od 2 mm s hipoglobusom ili diplopijom te veliki pomak koštanog fragmenta indikacije su za rani odgođeni kirurški zahvat unutar 2 tjedna od traume orbite. Najčešće korišteni materijali u rekonstrukciji frakture dna orbite su titanijska mrežica i porozni polietilen.

Abstract (english)

Orbital floor blow out fractures are depicted as loss of continuity of the orbital floor while the orbital rim remains intact. It typically results from a direct impact to the orbital rim or to the orbit itself. There are two main theories describing mechanisms of fractures. The first one states that when orbital pressure increases it causes bone rupture and orbital content displacement to adjacent sinuses, thus known as hydraulic theory. The second theory postulates that the orbital wall bends as a result of direct blow to the infraorbital rim. However, both hydraulic and buckling can cause blowout fractures, but with different clinical and radiological characteristics. Clinical findings such as diplopia in upward gaze, enophtalmos, V2 distribution hypoesthesia, periorbital ecchymosis or oedema indicate high correlation of orbital blow out fracture. Multi-slice CT remains the imaging technique of choice, as it provides rapid, detailed information regarding orbital fracture location, size soft tissue involvement. Indications for immediate surgery include retrobulbar haematoma and „white-eyed“ blowout fractures in children or oculocardiac reflex due to muscle entrapment. Enopthalmos greater than 2 mm with significant hypoglobus or diplopia, large displaced fractures are indications for early surgical intervention within 2 weeks. The materials commonly used for orbital reconstruction include titanium mesh and porous polyethylene sheeting.

• Keywords: frakture orbite; diplopija; MSCT; titanijska mrežica; uklještenje mišića
• Keywords (english): orbital fractures; diplopia; MSCT; titanium mesh; muscle entrapment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:641965
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-10 16:40:57