Nerve Of The Orbital Floor
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In patients with orbital floor fractures visual loss can result from globe trauma injury to the optic nerve or increased orbital pressure causing a compartment syndrome discussed in the section traumatic visual loss with clear media.
Nerve of the orbital floor. The infraorbital groove or canal through which the infraorbital nerve cn v 2 branch and artery travel divides the floor. Medially near the orbital margin is located the groove for nasolacrimal duct. The inferior orbital fissure lies just below the superior orbital fissure between the lateral wall and floor of the orbit. The inferior orbital neurovascular bundle comprising the infraorbital nerve and artery courses within the bony floor of the orbit.
Here the nasociliary nerve is located between the 2 sections. An orbital hemorrhage should be suspected if loss of vision is associated with proptosis and increased iop. The cause of the fracture is thought to be from increased intraorbital pressure which causes the orbital bones to break at their weakest point. The floor inferior wall is formed by the orbital surface of maxilla the orbital surface of zygomatic bone and the minute orbital process of palatine bone.
The 2 sections of oculomotor nerve goes into the orbit via superior orbital fissure inside the common tendinous ring. It transmits the infra orbital nerve which can be harmed in blow out fractures resulting in parasthesia below the lower eyelid. The smaller superior office runs forwards above the optic nerve and supplies the superior rectus then pierces it to supply the levator palpebrae superioris. Direct fractures of the orbital floor can extend from orbital rim fractures while indirect fractures of the orbital floor may not involve the orbital rim.
It contains veins the infraorbital artery and nerve and the zygomaticofacial nerve. Near the middle of the floor located infraorbital groove which leads to the infraorbital foramen. This is usually the medial orbital floor. 1 orbital floor fractures pose a great threat to infraorbital nerve causing entrapment and compression.
The roof of this infraorbital canal is only 0 23mm thick and the bone of the posterior medial orbital floor averages 0 37 mm thick. The orbital floor separated from the lateral wall by the inferior orbital fissure consists of the zygomatic maxillary and palatine bones. In patients with orbital fractures it is imperative that the globe be examined. The floor forms the roof of the maxillary sinus.
An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall typically resulting from impact of a blunt object larger than the orbital aperture or eye socket most commonly the inferior orbital wall i e. Acute loss of sensory function of the infraorbital nerve follows which may be due to compression edema ischemia or contusion neurotmesis. Zygomatico orbital fractures are common among traumatic facial bone fractures due to their prominent position.
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