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European Journal of Plastic Surgery

, Volume 26, Issue 2, pp 96–98 | Cite as

Medial orbital wall fracture with concomitant medial longitudinal fasciculus lesions

  • H. FındıkEmail author
  • N. Karacaoğlan
  • A. Duman
  • A. Mısıroğlu
Case Report
  • 56 Downloads

Abstract

Isolated orbital fractures are rare and may cause entrapment of intraocular muscles. The medial longitudinal fasciculus extending bilaterally through the brainstem establish connections between III, VI, VIII, and XIth cranial nerves. Lesions of these fasciculi may cause clinical findings similar to those seen in orbital fractures leading to muscle entrapment. A 9-year-old girl suffered a crush trauma. She had a limited inward gaze of left eye and complaints of diplopia. Findings were thought to be secondary to a left medial orbital wall fracture detected by cranial computed tomography, there was also entrapment of the medial rectus muscle. The patient was evaluated for the presence of any intracranial pathology as nystagmus developed. Antioedema therapy was initiated. Cranial magnetic resonance imaging revealed multiple millimeter-sized lesions at the medial longitudinal fasciculus MLF of the pons. There was a dramatic improvement in clinical findings on the 17th day of antioedema therapy; a diagnosis of internuclear ophthalmoplegia was made, and the operation was canceled. The authors emphasize that clinical findings due to orbital fractures may also be signs of a concomitant intracranial lesion, and that this possibility should be considered in differential diagnosis

Keywords

Internuclear ophthalmoplegia Orbital fracture 

Notes

Acknowledgements

This case was presented at the XXIth National Plastic, Reconstructive and Aesthetic Surgery Congress, 30 September - 3 October, 1999, Kuşadasi, Turkey.

References

  1. 1.
    Adams RD, Victor M, Ropper AH (1987) Principles of neurology, 6th ednGoogle Scholar
  2. 2.
    Aston SJ, Beasley RW, Thorne CHM (1997) Facial fractures. In: Grabb and Smith's plastic surgery, 5th edn. Lippincott-Raven, New York, p 393Google Scholar
  3. 3.
    Bradley WG et al. (1991) Brain stem syndromes. In: Neurology in clinical practice, 2nd edn, vol 1. Butterworth-Heinemann, Boston, p 275Google Scholar
  4. 4.
    Dortzbach RK (1994) Blow-out fractures of the medial orbital wall. Ophthal Plast Surg 211Google Scholar
  5. 5.
    McCarthy JG (1990) Plastic surgery, vol 2. Saunders, PhiladelphiaGoogle Scholar
  6. 6.
    Nesi FA, Lisman RD, Levine MR (1998) Ophthalmic plastic and reconstructive surgery, 2nd edn. Mosby, St. LouisGoogle Scholar
  7. 7.
    Patten J (1996) Conjugate gaze mechanisms. In: Neurological differential diagnosis, 2nd edn. Springer, Berlin Heidelberg New York, p 97Google Scholar
  8. 8.
    Rowland LP (1995) Symptoms of neurologic disorders. In: Merritt's textbook of neurology. Williams and Wilkins, Philadelphia, 9th edn, p 40Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • H. Fındık
    • 1
    • 2
    Email author
  • N. Karacaoğlan
    • 2
  • A. Duman
    • 2
  • A. Mısıroğlu
    • 2
  1. 1.Bağlarbaşı Soyak Evleri C9 Blok-Daire 4, Üsküdar IstanbulTurkey
  2. 2.Plastic and Reconstructive Surgery ClinicHaydarpasa Numune Education and Research HospitalIstanbulTurkey

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