Traumatic Globe Subluxation into the Paranasal Sinuses: A Case Report and Literature Review

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.

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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.

 

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Publikationsverlauf

Artikel online veröffentlicht:
07. Februar 2025