Classification, clinic and diagnosis of orbital fractures (literature rev)

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Гафуров Z., Абдуллаев S., Юсупова D., & Нишанов Z. (2022). Classification, clinic and diagnosis of orbital fractures (literature rev). in Library, 22(1), 19–34. извлечено от https://inlibrary.uz/index.php/archive/article/view/14608
З Гафуров, Ташкентский государственный стоматологический институт

ассистент кафедры болезней и травм челюстно-лицевой области

Ш Абдуллаев, Ташкентский государственный стоматологический институт

доктор медицинских наук, профессор, заведующий кафедрой болезней и травм полости рта и челюстно-лицевая область

Д Юсупова, Ташкентский государственный стоматологический институт

Кандидат наук, ассистент кафедры челюстно-лицевых болезней и травм

Ж Нишанов, Ташкентский государственный стоматологический институт

Врач-ординатор кафедры челюстно-лицевой хирургии

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Сrossref
Scopus
Scopus

Аннотация

Orbital contusion trauma is characterized by particular severity, a high risk of blindness, the possibility of the development of purulent-inflammatory complications, and functional and cosmetic defects [1]. The multiple  nature  of  traumatic  injuries  necessitates  the  use  of  accurate  topical  diagnosis  and  treatment planning. The study of traumatic lesions of the orbit is relevant.

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A

BSTRACT

Orbital contusion trauma is characterized by particular severity, a high risk of blindness, the possibility of

the development of purulent-inflammatory complications, and functional and cosmetic defects [1]. The
multiple nature of traumatic injuries necessitates the use of accurate topical diagnosis and treatment

planning. The study of traumatic lesions of the orbit is relevant.


K

EYWORDS

Contusion injury, orbit, fractures.

Journal

Website:

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s.org/journals/index.ph
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Copyright:

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content from this work
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Research Article

CLASSIFICATION, CLINIC AND DIAGNOSIS OF ORBITAL
FRACTURES (LITERATURE REV)

Submission Date:

February 19, 2022,

Accepted Date:

March 04, 2022,

Published Date:

March 14, 2022

Crossref doi:

https://doi.org/10.37547/medical-fmspj-02-03-03

Z.A.Gafurov

Assistant Of The Department Of Disease And Trauma Of The Oral And Maxillofacial Area
Tashkent Dental Medical Institute, Uzbekistan

Sh. Y. Abdullaev

Doctor Of Medicine, Professor, Head Of The Department Of Diseases And Trauma Of The Oral And
Maxillofacial Area Tashkent Dental Medical Institute, Uzbekistan

D.Z. Yusupova

Ph.D. Assistant Of The Department Of Maxillofacial Disease And Trauma Tashkent Dental Medical Institute,
Uzbekistan

J.H.Nishanov

Resident Physician At The Maxillofacial Surgery Department Tashkent Dental Medical Institute, Uzbekistan


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I

NTRODUCTION

Orbital contusion trauma accounts for 36 to 64%

of all injuries to the facial skeleton involving the
visual organ and its accessory organs [1, 2]. About

85% of all orbital injuries requiring inpatient

treatment are bone wall integrity disorders [3].

According to epidemiological studies, in Russia,

there is an absolute prevalence of domestic

(64.5%) orbital injuries over criminal (21.7%)

and occupational (15.5%) injuries [1, 4]. This

pattern is not so much due to a decrease in the

number of criminal and occupational orbital
injuries per se, as to the fact that in many cases

they are reported by the patient as domestic [5].

Many authors have noted an increase in orbital

transport injuries in the last 5 years, from 4.9% in

2007 to 12.8% in 2010, due to an increase in the

number of vehicles, high road speeds, and alcohol

consumption behind the wheel [2, 6, 7].Orbital
injuries are often the result of sports activities [3].

According to the data of employees of

ophthalmology department of Perm medical

institute in 10 years (2000 - 2010) the sports

traumatism accounts for 9 - 11 % of fractures of

bones of the medial zone of facial skeleton [8].

The bones of the middle zone of the facial

skeleton are also involved in the formation of the
orbit, so injuries to this zone are reflected in the

nature of damage to the bony walls of the orbit.

Fractures of the midface are associated with

orbital fractures in 80% of cases [4], with isolated

fractures of the lower orbital wall being the most

common, accounting for 6-12% [9]. In 29 - 37% of

patients, fractures of two orbital walls are
identified. Fractures of three orbital walls were

reported in 12 - 18 % of patients and all four walls

in 3 - 7 % of patients. In the structure of all orbital

diseases in peacetime, according to the Military

Medical Academy of St. Petersburg (MMA St.

Petersburg), orbital damage ranges from 2% to

8% [4], and in children it is 0.9% [10]. In children,
fractures of the bony walls of the orbit in blunt

trauma account for 23% of all facial injuries. Of all

orbital fractures encountered in pediatric

practice, 25 to 70% are linear fractures of the

inferior wall without displacement of the

fragments, a trap fracture with impingement of

the inferior rectus muscle [3, 11]. Orbital trauma
is combined with injuries of ENT organs in 92 %,

maxillofacial region in 47 %, skull and brain

bones in 45 %, other organs in 11 % of cases,


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according to data of the Military Academy of St.

Petersburg. In 65-66% of cases, orbital trauma is

combined with contusions of the eyeball and its

accessory organs [4, 12]. The ophthalmology

literature distinguishes between orbital soft

tissue contusion without orbital fracture and with
fracture (13). Most cases of orbital contusion

injury are unilateral, with bilateral injury

occurring less frequently. In terms of incidence,

orbital bone wall fractures in orbital contusions

are one of the most common midface injuries and

account for 31% [3]; in children, 23% of all left

skeletal injuries [10]. Orbital contusions without

fracture occur in 78% of all orbital injuries (13).

The social significance of orbital trauma is
determined by the young working age of the

patients, with a bimodal distribution of orbital

contusions with peak frequency at the ages of 16-

21 and 39-55 years, reduced adaptation to

working life with diplopia in 89%, resulting in

significant economic losses [6, 14].

A significant difference was found in the gender

distribution of orbital trauma, with three quarters

of the victims being men [3].

The possibility of seasonality in the incidence of

orbital trauma was also investigated. For

example, it has been noted that the number of

orbital bone wall fractures increases sharply

between April and October; according to other

data, this occurs between July and September [2].

In an analysis of the population of orbital trauma

victims, 42% of cases were found to be under the

influence of alcohol at the time of injury.

Classification of orbital trauma. According to
Gundorova's classification (2009), orbital

trauma is divided into domestic, transport,

criminal, occupational, sports, agricultural,

man-made, and pediatric [1].

In the literature, the only complete
classification of orbital fractures is proposed

by Nikolaenko V.P. (2009), according to which

the most common types of orbital fractures,

which may occur in isolation or in various

combinations with other facial injuries, are
identified.- "Blast and depressed fractures of

the inferior wall of the orbit;

Explosive and depressed fractures of the inner
wall of the orbit;

Fractures of the zyco-orbital complex;

Le Fort I, II, III* fractures of the upper jaw;

Nasoethmoid fractures;

"Blasted" and depressed fractures of the

upper orbital wall;


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Fronto-basal

fractures

(including

supraorbital, glabellar, and isolated fractures

of the superior orbital margin);

Fractures of the orbital apex, including

concomitant damage to the optic nerve canal;

Local fractures caused by sharp objects
inserted into the orbit.

*Top jaw fractures account for 2-5% of all
facial bone fractures. The most common

classification of maxillofacial fractures is

LeFort (1901). It distinguishes between three

main fracture types (3).

Inferior (LeFort-I; transverse). Its line runs in
the horizontal plane. Starting at the edge of

the sternal foramen on both sides, it runs to

the back above the level of the floor of the

maxillary sinus and passes through the
tubercle and the lower third of the pterygoid

process of the sphenoid bone.

Medial (Lefort-II; suborbital).

Its line runs through the junction of the frontal

process of the maxilla with the nasal part of

the frontal bone and the nasal bones

(nasolabial suture), then runs down the
medial and lower walls of the eye socket,

crosses the bone along the suborbital margin

and reaches the pterygoid process of the

sphenoid bone. The cervical bone with the

crenoid plate is often injured.Upper

(Lephorus-III; subbasal). Its line runs through

the nasolabial suture, along the inner and

outer walls of the eye socket, up to the upper

part of the pterygoid process and the div of
the sphenoid bone. At the same time the

zygomatic process of the temporal bone and

the nasal septum are broken vertically. This

causes the facial bones to separate from the

skull bones. The orbit is affected by subbasal

and suborbital fractures. Traumatic fractures

of the upper jaw are bilateral according to
LeFort classification, and their lines run

symmetrically. The typical location of fracture

lines is rare, more often the fracture line is

atypical or asymmetrical [13].Scientific

papers focus on the inferior wall, as it is the

most

frequently

injured

in

orbital

trauma.According to the classification of A. С.
Kiselev (2006) identified types of 'blast'

fractures of the lower orbital wall:

Small splintering, when the lower orbital wall
is "scattered" into a large number of small

fractures and is practically absent in a certain

area, depending on the fracture;

Large splintering, consisting of one or two
large fractures that sink into the cavity of the


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maxillary sinus together with the tissues of

the eye cavity;

The fractures do not lose their connection
with the bone and tend to return to their

original position, impinging on the ocular

tissues that are wedged between them.

In addition, Prof. V. P. Ippolitova (2004)

developed a classification of post-traumatic

deformities of the midface based on the clinical

and radiological picture of zygomatic-orbital

complex (SOC) injuries. M. Khitrina (2007) based

on her classification, developed a working
scheme for fractures of the zygomaticorbital

complex (SOC), features:

Excludes the term "fracture of the zygomatic

bone" as the fracture lines are always localized

outside the zygomatic bone with involvement of

the orbital margins and walls.

Considers the multiple fractures of the MRL and

highlights the localisation of the maximal

displacement and diastasis, which facilitates the

choice of surgical treatment.

5 fracture groups:

1.

Fractures of the SSS with maximal fragment

displacement and diastasis along the inferior

orbital margin.

2.

Fractures of the CEA with maximal

displacement of the fragments and diastasis

along the zygomatic suture.

3.

Multiple SDS fractures without pronounced

diastasis between the fragments.

4.

Fractures of the ETS combined with fractures,

orbital floor defect.

5.

Fractures of the zygomatic arch [15].

According to the working classification of

Gorbunova E. Д. (2006) fractures of the lower

orbital wall in children according to clinical and

radiological signs: presence and terms of
disappearance of diplopia, limitation of eyeball

mobility, transverse size of the through defect,

magnitude of displacement of the lower orbital

wall towards the maxillary sinus, presence of CT

signs of orbital soft tissue impingement in the

fracture area.

1.

CT - signs of fracture with transverse size of

the penetrating defect up to 0.5 cm and

minimal displacement of the lower orbital
wall up to 0.2 cm, without signs of orbital soft

tissues impingement in the fracture zone.


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Clinical signs (diplopia, limitation of mobility)

disappear on the 2nd - 5th day.

2.

CT - signs of fracture with transversal

dimension of the penetrating defect more

than 0,5 cm and displacement of the lower

orbital wall more than 0,2 cm, without signs of
impingement of orbital soft tissues in the

fracture zone. Clinical signs (diplopia,

limitation of mobility of the eyeball) disappear

on the 7th to 10th day.

3.

CT - signs of a fracture with impingement of

the orbital contents and its prolapse into the

maxillary sinus. The clinical signs (disruption
of

ocular

mobility,

double

vision,

enophthalmos,

including

progressive

enophthalmos) remain unchanged [10].

Definition and mechanism of orbital contusion

injury. An orbital contusion is a closed, non-

dermal injury resulting from blunt force

(contusion, compression) to the bony walls of the

orbit and its contents [1].

Blunt orbital trauma is caused by a blow in which

the injuring object is in motion: a blow with a fist,

leg, stick, log, puck, ball, swing; or in which the
subject remains motionless: a fall to the ground

from a height (from a tree, bicycle), a traffic

accident [11, 13]. A detailed assessment of the

mechanism of orbital trauma in a contusion is

helpful in making the diagnosis. For example, if

the blunt solid object is smaller than the orbital

inlet, the patient may develop a subconjunctival

scleral tear without damage to the orbital bone

walls. If the size of the damaging object is larger
than the orbital inlet, there are two possibilities:

with the impact of an agent with relatively low

velocity and low kinetic energy, an "explosive"

fracture of the orbital wall (lower or inner); with

a strong impact, a combined fracture (lower

ocular margin and the orbital floor or inner wall;

upper ocular margin and inner wall, the orbital
roof) [1]. If the impacting object is large and has

high kinetic energy, it causes not only a fracture

of the "bone ring" of the orbit, but also of other

facial bones, up to and including the formation of

panfacial fractures [3].

The type of injury in orbital contusions is

determined by the condition of the eyeball and

the anatomical features of the orbital structure. If

the outer membranes of the eye are incomplete,
e.g. after keratotomy or scleromalacia, the eye

"capsule" is torn and this "saves" from a fracture.

The normal eyeball in a contusion does not

rupture with a blunt flat blow, but deforms and

shifts deep into the orbit, compressing its


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contents and sharply increasing intraorbital

pressure, which causes the weakest lower wall of

the orbit to push into the maxillary sinus [3, 15,

16].

The anatomic structure of the lower orbital wall -

thin periosteum, honeycomb structure of the

cancellous substance, and topographic location -

nodal position in the system of natural bone
connections of the orbit result in a high incidence

of isolated and combined fractures in 87.3 %. Less

common are isolated and combined external,

upper, and internal wall fractures in 15.8% [1, 9].

Takizawa et al. (1998) demonstrated from

experiments

and

subsequent

computer

simulations that the contour (profile) of the
orbital walls plays an important role. In

particular, an arch-shaped orbital roof is much

more resistant to deformation than a nearly flat

bottom, which deforms and breaks more easily.

The inner wall of the orbit is even thinner, but the

lattice labyrinth cells reinforce it at the back like

buttresses, so more mechanical energy is
required to fracture the medial wall than to

fracture the orbital floor [3, 13]. The reflex

contraction of the orbital circular muscle and the

presence of a large air cavity beneath the orbit

also contribute to more frequent damage to the

lower

orbital

wall

(17).

It

is

the

underdevelopment of the maxillary sinus and the

continued growth of the orbit that accounts for

the rarity of orbital floor fractures in children

under 7-8 years of age [3,18].

In 'straight' fractures the zygomatic bone is

injured and 'breaks out' along the joints

connecting it to the frontal, temporal and
maxillary bones. The entire force of the impact

falls on the edges of the orbit, causing them to

fracture or terminate in the formation of fractures

in the trauma area, or spread inward along the

walls. Such a fracture is accompanied by almost

complete loss of the lower orbital wall [ 19 ].

The clinical presentation of orbital trauma in

contusion in the acute period is determined by

the localization of the fracture of the orbital bone
wall. Symptoms of fracture of the lower orbital

wall are well described: oedema, eyelid

haematoma, hypophthalmos, bulbar conjunctiva

chemosis, downward displacement of the eyeball

(hypophthalmos), limitation of active and passive

eye movements, impaired sensitivity in the zone

of innervation of the suborbital nerve [1, 3].

Symptoms of fracture of the inner wall of the orbit

are not as clear as those of the lower wall:


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emphysema of the eyelids, conjunctiva, unilateral

nasal bleeding. In the case of a fracture of the

inner wall of the orbit, enophthalmos with

impingement of the internal rectus muscle in the

fracture zone has been observed [9, 20]. In this

type of fracture, the medial ligament of the
eyelids, the lacrimal ducts and the lacrimal sac

can also be damaged [1].In fracture of the upper

orbital wall, along with a severe general state of

the patient, eyeball movement disorders, upper

orbital slot syndrome, pulsating exophthalmos,

anisocoria due to impaired pupillary innervation,

optic nerve damage in the bone canal, opto-nerve
path, lycvoria, "glasses symptom" are common [1,

21]. Symptoms of fracture of the external wall of

the orbit, which includes the zygomatic complex

(facial asymmetry, disruption of the contour of

the zygomatic bone, limitation of lateral and

downward movements of the lower jaw when

opening the mouth). There is also displacement of
the eyeball, limitation of active and passive

movements, and damage to the external

commissure of the eyelid [1, 13].The complexity

of the clinical examination of patients with orbital

trauma is due, on the one hand, to the uniformity

of clinical symptoms in various orbital and optic

nerve injuries, on the other hand, to the
inaccessibility of the orbit for examination and

limited known examination techniques, and the

difficulty

of

differential

diagnosis

with

intracranial and optic tract injuries [3].Clinical

Examination This explains the importance of the

radiological diagnosis stage, which aims to clarify

and confirm the clinical diagnosis, develop an
optimal treatment strategy and determine the

prognosis of orbital trauma [1, 22].

The diagnosis of orbital trauma in contusion is

difficult due to the need to use various

instrumental methods to examine the orbit (3).

Radiological diagnosis is the leading method for

examining the orbit. The diagnosis of traumatic

injuries to the orbital bone structures begins with

traditional cranial radiography in straight, lateral
and anterior semiaxial projections, or orbital

radiography in 2 projections. In case of suspicion

of injuries of the posterior wall of the orbit, optic

nerve canal, frontal, metacarpal bone, the

targeted X-ray of the orbital region is carried out

by the method of O. According to different

authors, many time-consuming radiological
examinations are not very informative and often

mislead the doctor and significantly delay the

diagnosis. The probability of error (missed X-ray

fracture diagnosed by subsequent coronary

computed tomography) is 10 - 13% for an inferior


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wall fracture and 20 - 27% for an inferior wall

fracture. However, radiography is 100% effective

in diagnosing a fracture of the upper and outer

orbital wall [3, 10, 22, 23, 24]. Therefore, at

present, X-rays of the skull and orbital cavity in

frontal, lateral and anterior semiaxial views are
used only at the admission stage as a screening

method. When analysing the radiographs

obtained, attention is mainly paid to indirect signs

of orbital damage: darkening of the orbit due to

marked swelling of the eyelids and retrobulbar

tissue in the area of damage, air in the upper parts

of the orbit.

It can diagnose gross fractures of the orbital wall,

large bone fragments, and haemosinus by
obscuring the sinus cavity adjacent to the fracture

area [22].The disadvantages are that it is not

possible to assess changes and the interposition

of the soft tissues of the orbit with the bone

structures (impingement, shape changes, muscle

tears), and to determine the extent of the fracture

towards the orbital apex and the width over the
entire length. In radiography there is projection

layering of bones, so it is impossible to get an idea

of small fractures with small fragments or

fractures of thin bones, comminuted fractures

without significant displacement, establish the

presence of bone fragment penetration into the

skull cavity, sinus cavities. X-rays cannot be used

to assess and decide if surgical intervention is

necessary [6, 10, 23].

Conventional radiography can be limited to the

determination of an extensive orbital fracture

with an appropriate clinical picture. If the

traditional radiological examination is positive
and the radiologist gives a negative opinion and

the clinician's suspicions remain, the patient is

referred to a computed tomography (CT) scan for

a detailed diagnosis of the features of orbital

contusions (19). Emergency CT scanning is

becoming the reality of our time as the method of

choice. Although the optimal time for CT scanning
is considered to be a delayed period after orbital

trauma (soft tissue swelling reduction) [3, 25].

The advantages of CT scanning are its ability to

differentiate tissues of different density due to

high resolution (to define the condition of orbital

bone structures, eye cavity and orbital contents),

noninvasiveness, small time and financial
expenses. Furthermore, CT scanning data can

clearly visualize small and combined (several

walls) fractures, estimate the size and position of

bone fragments, diagnose complications of

contusion trauma such as retrobulbar and


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subperiosteal

hematoma,

hemorrhage

in

subchain optic nerve space, extraocular muscles,

and diagnose the condition of mucosa of

accessory sinuses (signs of hemorrhage and

inflammation) [3, 10].

A significant disadvantage of CT scanning,

especially multiple scanning, is the radiation load

on the lens [3, 26].

For a complete analysis of lesions of the orbital

bone and its contents, the examination is

performed in two planes at 1.25 mm increments.
Coronal (frontal) tomograms are more

informative when analysing deformities, defects

of the lower and upper walls of the orbit, orbital

herniation into the maxillary sinus or cerebral

herniation into the orbit, tears and extraocular

muscle-bone fusion sites. Axial slices better
visualize fractures of the medial and lateral walls

of the orbit, optic nerve and optic nerve canal, and

the shape of the straight extraocular muscles [26,

27]. When analyzing CT data in unilateral

fractures, attention is paid to the symmetry of the

shape and volume of the orbit, the position of the

eyeballs and extraocular muscles, the condition of
the optic nerve and its bone canal, and the

presence of foreign bodies [1, 28]. In normal cases

the eyeball occupies a central position in the orbit,

its displacement close to any wall shows the

impingement of the corresponding muscle in the

fracture zone. The shadows of straight muscles

are normally 0.1-0.3 cm away from the bone

walls. If there is no X-ray-negative stripe between

the muscle and bone, scar fusion or impingement
of the muscle and bone is suspected [3, 10, 26].

Minor comminuted fractures are characteristic of

"blast" fractures of the orbit with damage to the

thin bones of the labyrinth or the lower orbital

wall.

Fractures in the form of a fracture are usually

found in 'blast' fractures (lower wall fracture) and

fractures of the frontal bone (upper wall

fracture). The CT scan helps to identify secondary
involvement of the inferior and inner rectus

muscles near the displacement of bone fragments

in blast fractures of the orbital wall, differentiates

the causes of diplopia due to muscle impingement

and muscle haematoma development, and helps

to identify parabulbar soft tissue prolapsed into

the sinuses adjacent to the orbit [1, 27, 28].
Coronary imaging may be impeded by the

patient's poor general condition, the presence of

an intubation tube in the trachea (its image

overlays the orbital contours), or trauma to the

neck preventing hyperextension. In these cases,


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VOLUME

02

I

SSUE

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Pages:

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SJIF

I

MPACT

FACTOR

(2021:

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)

(2022:

5.605

)

OCLC

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METADATA

IF

6.986















































Publisher:

Frontline Journals

spiral

computed

tomography

(SCT)

or

multidetector spiral computed tomography

(MSCT) are indispensable. They are characterized

by high diagnostic informativeness, high scanning

speed, possibility of imaging orbits in bone and

soft tissue modes, creating 3D and multiplanar
reformations based on multiple slices - high

frequency scanning. In addition, overextension of

the neck is no longer necessary to obtain coronal

slices [29, 30].Many authors claim that CT and

MSCT techniques will eliminate the need for

magnetic resonance imaging (MRI) in patients

with orbital trauma. However, the use of these
techniques in the diagnosis of orbital contusion

injury has been reported in the literature by a few

authors [31].

In addition, a method of noninvasive low dose (2

mSv) functional MSCT (fMSCT) of extraocular

muscles in orbital trauma was developed by the

staff of the Sechenov First Moscow State Medical

University Department of Radiation Diagnostics.

The study is performed in dynamic scanning
mode according to the program of bone and soft

tissue reconstruction with a slice thickness of 0.5

mm in axial projection, followed by obtaining

multiplanar

and

three-dimensional

reconstructions

with

simultaneous

eye

movement in a certain sequence. When fMSCT is

performed in the presence of functional muscle

activity, extraocular muscle fixation in the

fracture zone can be detected. In the absence of

movement and contractility of a muscle, paralysis

of nerves involved in muscle innervation can be
confirmed or muscle detachment from the eyeball

from the vertex of the orbit can be diagnosed [32].

These include the presence of a pacemaker, metal

implants, permanent makeup and tattoos (which

create artifacts and impede the interpretation of

images), claustrophobia, pregnancy and lactation,

and uncontrolled movements of the patient
during the examination. MRI can be used to assess

the anatomico-topographical relationship of the

orbital structures to the sinuses and brain [ 1,31

].

Ultrasound

(ultrasound;

two-dimensional

imaging system) of the orbit and eyeball

structures for orbital contusions, allows you to

see a cross-section of the eye in a given scanning

plane with its structural changes. Ultrasound can
assess the shape, size, clarity of contours,

structure, echogenicity of eyeballs, as well as the

location and size of the main intraocular

structures: cornea, anterior chamber, iris, ciliary

div, lens, vitreous div, retina, vasculature;


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VOLUME

02

I

SSUE

03

Pages:

19-34

SJIF

I

MPACT

FACTOR

(2021:

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)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

condition of optic nerve area, retrobulbar space,

extraocular muscles [32, 33].

In recent years, ultrasound diagnosis of orbital

fractures in contusive orbital trauma has been

actively introduced [34]. The main arguments are

economic feasibility, widespread availability of

ultrasound equipment, also the absence of

radiation exposure and the possibility of long-
term investigation. The use of ultrasound to

diagnose fractures of the lower edge and anterior

parts of the orbital floor proved to be the most

justified; the method was proposed by Medvedev

Y.A. and Konyakhin A.F. (2007). The principle of

the method consists in drawing on the patient's

face the scheme of the location of ultrasound
probes to study the bone tissue throughout the

fracture line on the injured side and the same

amount of bone tissue on the undamaged side,

taking into account the complex topography and

anatomico-topographic structure of the midface

bones.Based on this method, it is determined that

the rate of ultrasound signal transmission is
slower on the injured side compared to the

healthy side, in the dynamics the line of injury

approaches the indicators of the healthy side.

Dynamic studies provide data on the course of

reparative processes along the fracture line,

enable timely transition to functional treatment,

assess a particular method of fixation of bone

fragments, and reduce the number of radiological

studies [35].

In conclusion, the incidence of blunt orbital

trauma among all injuries to the facial skeleton

involving the visual organ and its accessory

organs ranges from 36 to 64%. In the early stages,
the uniformity of clinical symptoms does not

allow a precise topical diagnosis to be made.

Different diagnostic methods (X-ray, CT, MSCT,

fMSCT, MRI, ultrasound) are currently used to

diagnose the localization of the orbital injury site.

However, the published literature does not

provide clear indications for the use of each of
these methods. To systematize and build an

effective, targeted algorithm for the examination

of patients with blunt orbital trauma is the task of

our further research.

R

EFERENCES

1.

Gundorova R. A., Neroev V. V., Kashnikov V.
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2009. - С.

2.

Gundorova R.A., Kapelyushnikova N.I.

Structure of eye traumatism. / New

technologies in plastic surgery of eye


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(ISSN

2752-6712)

VOLUME

02

I

SSUE

03

Pages:

19-34

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

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N.I.,

Gurdjian

K.D.

Peculiarities of diagnostics and treatment
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technologies in plastic surgery of the eye

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Moscow, 2007. - С. 25-27.

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Kataev M.G., Yolchiyan S.A., Tishkova A.P.
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Panina O.L. Combined severe trauma of

the eye socket: Author's abstract. In the

case of the concomitant severe trauma to

the orbital cavity: Author's abstract of

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Gorbunova E. D. Clinic, diagnosis and
treatment of orbital wall fractures in

children: Author's dissertation. D. in

medical sciences. - М., 2007.

11.

Nagase D. Y., Courtemanche D. J., Peters D.

A. Facial fractures - association with ocular

injuries: a 13 - year review of one practice

in a tertiary care center / Can. J. Plast.
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Danilichev V.F., Kiselev A. S., Gorbachev

D.S., Lugina V. D. Combined injuries of

orbit and ENT-organ / Actual problems of

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1996. - С . 39 - 41.


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(ISSN

2752-6712)

VOLUME

02

I

SSUE

03

Pages:

19-34

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

13.

Josef J. M., Glavas I. P. Orbital fractures: a

review / Сlinical Ophthalmology. - 2011. -

V.5. - P. 95 - 100.

14.

Brown M. S., Ky W., Lisman R. D.

Concomitant ocular injuries with orbital

fractures / The Journal of Cranio-
maxillofacial Trauma. - 1999. - V.5. - №3. -

P. 41-46.

15.

Khitrina M.M. Optimization of diagnosis

and treatment of patients with fractures of

the zygomatic-orbital region: Author's

abstract. D. in medical sciences. - М.,

2003.Bunstitle,

M.

A.

Clinical

recommendation for repair of isolated

orbital floor fractures / Ophtalmology. –

2002. –V. 109. – №7. – P. 1207–1210.

16.

Kang B. D., Jang M. H. A case of blowout

fracture of the orbital wall with eyeball

entrapped within the ethmoid sinus /

Korean J Ophthalmol. – 2003. – V. 17. – P.
149-153.

17.

Baek S. H., Lee E. Y. Clinical analysis of

internal orbital fractures in children /

Korean J. Ophthalmol. – 2003. – V.17. – P.

44–49.

18.

Karsterer P. A., Yunker C. Recognition and

management of an orbital blowout
fracture in an amateur boxer / J.of

orthopaedic and sport physical therapy. –

2006. – V. 36. – №8. – P. 610-616.

19.

Wang L., Wang J. On the positive

correlation between the percentage of

acute fracture of medial orbital wall and

the degree of injury of affected medial
rectus muscle by CT image / European

Journal of Radiology. – 2011. – Vol. 17. – №

6. – Р. 154–158.

20.

Song W. K., Lew H., Yoon J. S., Oh M. J., Lee

S. Y. Role of medial orbital wall

morphologic properties in orbital blow-

out

fractures

/

Investigative

Ophthalmology and Visual Science. – 2009.

– V.50. – №2. – P. 495–499.

21.

Filatova I. A., Tishkova A. P., Beraya M. Z.,

Polyakova L.Y., Tkhelidze N.R. Computer

tomography

in

diagnosing

and

determining treatment tactics in patients

with posttraumatic pathology of the eye
and orbit / Vestnik ophthalmologii. - 2005.

- N 6 - P. 9-14.

22.

Sangaeva L.M., Vyklyuk M.V. Radial

diagnostics of eye and orbital structures

traumas / Vestnik roentgenologii i

radiologii. - 2007. - № 2. - С. 60 - 63.

23.

Gorbachev D. S., Lugina V. D., Mazur M.V.
Roentgenlocalization

of

the

basic


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(ISSN

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VOLUME

02

I

SSUE

03

Pages:

19-34

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

anatomic formations of an orbit in various

roentgenologic folds / New technologies in

plastic surgery of anterior appendage of an

eye and an orbit in conditions of

emergencies and accidents: Mater. of

scientific - practical conference. - M., 2007.
- С. 27-29.

24.

Jarrahy R., Vo V., Goenjian H. A., Tabit C. J.,

Katchikian H. V., Kumar A. K., Meals C.,

Bradley J. P. Diagnostic accuracy of

maxillofacial trauma two - dimentional

and three - dimentional computed

tomography scans: comparison of oral
surgeons, year and neck surgeons, plastic

surgeons, and neuroradiologists / Plast.

Reconstr. Surg. - 2011. - Vol. 127. - №6. - Р.

2432-2440.

25.

Kreipke D.L., Moss J.J., Franco J.M., Maves

M.D., Smith D.J. Computed tomography

and thin - section tomography in facial
trauma / American Journal of Radiology. -

2004. -V. 4. - №17. - P. 43-46.

26.

Trivellato P. F. A retrospective study of

zygomatico - orbital complex and / or

zygomatic arch fractures over a 71 - month

period / Dental Traumatology. - 2011. -

Vol. 27. - Р. 135-142.

27.

Shimia M., Sayyahmelli S. Traumatic

displacement of the globe into the brane /

The Journal of Pakistan Medical

Assosiation. - 2009. - V.34. - NO.2 - P. 234-

235.

28.

Antsiferova N.G., Puzyrevsky K.G., Plisov
I.L. Diagnostic significance of multislice

spiral computer tomography of orbits at

the posttraumatic heterotropia / N.G.

Antsiferova., // Fedorovsky readings:

Theses of VIII All-Russian scientific -

practical conference with international

participation. - М., 2009. - С.178 - 180.

29.

Amosov V. I., Speranskaya A. A., Lukina

O.V. The use of multispiral computer

tomography (MSCT) in ophthalmology/

Ophthalmological sheets. - 2008. - Vol. - №

3. - С. 54 - 56.

30.

Datsko A. A., Piven I. A., Obodov V.A.

Magnetic

resonance

imaging

in

diagnostics

and

treatment

of

posttraumatic eyeball dislocations in

fractures of the midface / Achievements,

unsolved problems and prospects of

stomatology development in the Urals:

Mater. nauch. - prakt. conf. - Ekaterinburg,

1999. - С. 20 - 21.


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Volume 02 Issue 03-2022

34



FRONTLINE MEDICAL SCIENCES AND PHARMACEUTICAL JOURNAL
(ISSN

2752-6712)

VOLUME

02

I

SSUE

03

Pages:

19-34

SJIF

I

MPACT

FACTOR

(2021:

5.14

)

(2022:

5.605

)

OCLC

1272874727

METADATA

IF

6.986















































Publisher:

Frontline Journals

31.

Danilov S. S., Chupova N.A. Functional

multispiral computer tomography in

diagnostics of the eye appendicular

apparatus injuries / Actual problems of

ophthalmology: collection of scientific

works of All-Russian conf. of young
scientists / Under edition of H.P.

Takhchidi. - М., 2011. - С. 97 - 99.

32.

Lezhnev D. A., Sangaeva L.M. Radial

technologies in diagnostics of the

combined injuries of facial cranium bones

and orbital structures / Siberian Medical

Journal. - 2010. -Tom 25. - №3. - С. 91-92.

33.

Shabrabi S.E., Kosy J. G., Thornton J. F.,

Hollier L. H. Facial fractures / Plastic and

reconstructive surgery. - 2011. -V. 9. - P.

25-34.

34.

Medvedev Y.A., Konyakhin A.F. Positive

decision on issue of patent for invention

"Method of ultrasound diagnostics of
fractures of lower edge and anterior parts

of orbital floor" from 14.01.2007,

Библиографические ссылки

Gundorova R. A., Neroev V. V., Kashnikov V. V. Eye trauma. - Moscow: GEOTAR-Media, 2009.-C.

Gundorova R.A., Kapelyushnikova N.I. Structure of eye traumatism. / New technologies in plastic surgery of eye appendages and orbital cavity in an emergency and catastrophic situations: Mater, nauch. conf. - M., 2007. - C. 152-154.

Nikolaenko V.P., Astakhov V.P. Part 1: Epidemiology and classification of orbital fractures. Clinic and diagnostics of the fractures of the lower orbital wall / Ophthalmologic reports. - 2009. - Volume II. - №2. - C. 56 - 70.

Danilichev V. F. Modern ophthalmology. -SPb: PITER, 2000. - C. 477-490.

Goncharenko N.I., Gurdjian K.D. Peculiarities of diagnostics and treatment of combined orbital trauma. / New technologies in plastic surgery of the eye appendages and orbital cavity in conditions of emergencies and disasters: Mater, of scientific-practical conference -Moscow, 2007. - C. 25-27.

Kataev M.G., Yolchiyan S.A., Tishkova A.P. Diagnostics and treatment tactics in orbital fractures / Vestnik Ophthalmologii. - 2006. - №1. - C.26 - 32.

Korotkikh S. A., Kuznetsova N.L., Kolesnikova E.I., Bobykin E.V. Sverdlovsk regional ophthalmotraumatology centre: results of 30 years work / XVI scientific -practical conference of Ekaterinburg centre MNTK "Eye Microsurgery": Mater. conf. - Ekaterinburg, 2008. - С. 57 - 61.

Chernysheva E. Z. The sport eye traumatism on materials of eye clinic of Perm medical institute for 10 years (2000-2010) I Voprosy ophthalmologii. - 2011. -№ 2. - C. 48-52.

Panina O.L. Combined severe trauma of the eye socket: Author’s abstract. In the case of the concomitant severe trauma to the orbital cavity: Author's abstract of medical sciences. - Л., 1986.

Gorbunova E. D. Clinic, diagnosis and treatment of orbital wall fractures in children: Author’s dissertation. D. in medical sciences. - M., 2007.

Nagase D. Y., Courtemanche D. J., Peters D. A. Facial fractures - association with ocular injuries: a 13 - year review of one practice in a tertiary care center I Can. J. Plast. Surgery. - 2006. - V.14. - №3. - P. 167-171.

Danilichev V.F., Kiselev A. S., Gorbachev D.S., Lugina V. D. Combined injuries of orbit and ENT-organ / Actual problems of modern ophthalmology: Mater. Saratov, 1996.-C. 39-41.

Josef J. M., Glavas 1. P. Orbital fractures: a review / Clinical Ophthalmology. - 2011. -V.5. - P. 95 -100.

Brown M. S., Ky W., Lisman R. D. Concomitant ocular injuries with orbital fractures / The Journal of Cranio-maxillofacial Trauma. - 1999. - V.5. - №3. -P. 41-46.

Khitrina M.M. Optimization of diagnosis and treatment of patients with fractures of the zygomatic-orbital region: Author's abstract. D. in medical sciences. - M., 2OO3.Bunstitle, M. A. Clinical recommendation for repair of isolated orbital floor fractures / Ophtalmology. -2002. -V. 109. - №7. - P. 1207-1210.

Kang В. D., Jang M. H. A case of blowout fracture of the orbital wall with eyeball entrapped within the ethmoid sinus / Korean J Ophthalmol. - 2003. - V. 17. - P. 149-153.

Baek S. H., Lee E. Y. Clinical analysis of internal orbital fractures in children / Korean J. Ophthalmol. - 2003. - V.17. - P. 44-49.

Karsterer P. A., Yunker C. Recognition and management of an orbital blowout fracture in an amateur boxer / J.of orthopaedic and sport physical therapy. -2006. - V. 36. - №8. - P. 610-616.

Wang L, Wang J. On the positive correlation between the percentage of acute fracture of medial orbital wall and the degree of injury of affected medial rectus muscle by CT image / European Journal of Radiology. - 2011. - Vol. 17. - № 6.-P. 154-158.

Song W. K., Lew H., Yoon J. S., Oh M. ]., Lee S. Y. Role of medial orbital wall morphologic properties in orbital blowout fractures / Investigative Ophthalmology and Visual Science. - 2009. - V.50. - №2. - P. 495-499.

Filatova I. A., Tishkova A. P., Beraya M. Z., Polyakova L.Y., Tkhelidze N.R. Computer tomography in diagnosing and determining treatment tactics in patients with posttraumatic pathology of the eye and orbit / Vestnik ophthalmologii. - 2005. - N 6 - P. 9-14.

Sangaeva L.M., Vyklyuk M.V. Radial diagnostics of eye and orbital structures traumas I Vestnik roentgenologii i radiologii. - 2007. - № 2. - C. 60 - 63.

Gorbachev D. S., Lugina V. D., Mazur M.V. Roentgenlocalization of the basic anatomic formations of an orbit in various roentgenologic folds / New technologies in plastic surgery of anterior appendage of an eye and an orbit in conditions of emergencies and accidents: Mater. of scientific - practical conference. - M., 2007. - С. 27-29.

Jarrahy R., Vo V., Goenjian H. A., Tabit C. J., Katchikian H. V., Kumar A. K., Meals C., Bradley J. P. Diagnostic accuracy of maxillofacial trauma two - dimentional and three - dimentional computed tomography scans: comparison of oral surgeons, year and neck surgeons, plastic surgeons, and neuroradiologists / Plast. Reconstr. Surg. - 2011. - Vol. 127. - №6. - P. 2432-2440.

Kreipke D.L., Moss J.J., Franco J.M., Maves M.D., Smith D.J. Computed tomography and thin - section tomography in facial trauma / American Journal of Radiology. -2004. -V. 4.-№17.-P. 43-46.

Trivellato P. F. A retrospective study of zygomatico - orbital complex and / or zygomatic arch fractures over a 71 - month period / Dental Traumatology. - 2011. -Vol. 27.-P. 135-142.

Shimia M., Sayyahmelli S. Traumatic displacement of the globe into the brane / The Journal of Pakistan Medical Assosiation. - 2009. - V.34. - N0.2 - P. 234-235.

Antsiferova N.G., Puzyrevsky K.G., Plisov I.L. Diagnostic significance of multislice spiral computer tomography of orbits at the posttraumatic heterotropia / N.G. Antsiferova., // Fedorovsky readings: Theses of VIII All-Russian scientific -practical conference with international participation. - M., 2009. - C.178 -180.

Amosov V. I., Speranskaya A. A., Lukina O.V. The use of multispiral computer tomography (MSCT) in ophthalmology/ Ophthalmological sheets. - 2008. - Vol. - № 3.-C. 54-56.

Datsko A. A., Piven I. A., Obodov V.A. Magnetic resonance imaging in diagnostics and treatment of posttraumatic eyeball dislocations in fractures of the midface / Achievements, unsolved problems and prospects of stomatology development in the Urals: Mater, nauch. - prakt. conf. - Ekaterinburg, 1999.-C. 20-21.

Danilov S. S., Chupova N.A. Functional multispiral computer tomography in diagnostics of the eye appendicular apparatus injuries / Actual problems of ophthalmology: collection of scientific works of All-Russian conf, of young scientists / Under edition of H.P. Takhchidi. - M., 2011. - C. 97 - 99.

Lezhnev D. A., Sangaeva L.M. Radial technologies in diagnostics of the combined injuries of facial cranium bones and orbital structures / Siberian Medical Journal. - 2010. -Tom 25. - №3. - C. 91-92.

Shabrabi S.E., Kosy J. G., Thornton J. F., Hollier L. H. Facial fractures / Plastic and reconstructive surgery. - 2011. -V. 9. - P. 25-34.

Medvedev Y.A., Konyakhin A.F. Positive decision on issue of patent for invention "Method of ultrasound diagnostics of fractures of lower edge and anterior parts of orbital floor" from 14.01.2007,

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