Introduction: Traumatic fractures of the orbital floor or medial wall with complete globe displacement
into the paranasal sinuses are rare and carry high risks of permanent vision loss
and persistent anatomical deformity despite appropriate surgical management. We report
a case of traumatic globe displacement into the maxillary sinus and review the relevant
literature.
Method: Case report and literature review. The literature review was conducted in PubMed/MEDLINE
and Google Scholar to identify studies published through May 2024, using keywords
including “orbital fracture,” “paranasal sinus,” “maxillary sinus,” “ethmoid sinus,”
and “globe displacement.” Non-English studies were excluded. Articles were evaluated
for injury patterns, etiologies, prognosis, and management. The results were synthesized
into a narrative review.
Results: A 77-year-old female presented with an empty left orbit after a motor vehicle accident,
exhibiting best-corrected visual acuity of 20/20 in the right eye and no light perception
in the left. CT imaging showed comminuted fractures of the left orbital floor and
medial wall, with herniation of the globe into the maxillary sinus, extensive orbital
hematoma, and transections of all extraocular muscles ([Fig. 1A]). Left globe volume and the optic nerve sheath complex were preserved ([Fig. 1B]), although the lateral aspect of the orbital floor appeared to exert mass effect
on the globe (red arrow on [Fig. 1A]). The patient underwent emergent surgical repair using a transconjunctival approach
to reposition the globe and repair the orbital floor with a porous polyethylene-coated
titanium implant affixed to the orbital rim ([Fig. 2]). Postoperatively, she showed gradual vision improvement, achieving counting fingers
vision by three weeks postoperatively. The patient continued to experience ptosis,
motility deficits, and progressive late enophthalmos. CT scan at 5-month follow-up
showed a good position of the left globe in the superior/inferior axis, with chronic
deformity of the left orbital floor and medial wall ([Fig. 3A]) and persistent enophthalmos ([Fig. 3B]). Subsequently, she underwent orbital floor and medial wall overlay using a custom
implant. Twelve months postoperatively, she had visual acuity of 20/40 but still experienced
complete movement deficit and residual enophthalmos. Literature review revealed 43
cases of traumatic globe displacement into the maxillary (34 [79.1%]) and ethmoid
(9 [20.9%]) sinuses published between 1970 and 2024. The most common injury mechanism
was motor vehicle accidents. Globe repositioning was attempted in 35 (81.4%) cases,
with orbit reconstruction in 29 (67.4%) cases. Enucleation was performed in 4 (9.3%)
cases. Traumatic optic neuropathy and vascular compromise were the most common mechanisms
of vision loss. Postoperative follow-up data from 38 cases revealed 16 (42.1%) achieved
final visual acuity better than no light perception. However, all but one case (97.4%)
experienced significant impairments in ocular motility and all had residual enophthalmos.
Fig. 1
Fig. 2
Fig. 3
Conclusion: Traumatic globe dislocation into the paranasal sinuses often results from severe
blunt trauma. The literature suggests that rapid surgical intervention is crucial
to optimize visual outcomes. However, late complications such as enophthalmos and
motility restrictions are common. Further research may help refine surgical techniques
and improve long-term functional outcomes for these patients.
