Eye Wide Shut

"I'm going to get a facial CT on this guy because his eye won't open," the resident said to me as he came out of the patient's room.Suddenly aware that a lateral canthotomy might be in our immediate future, I asked, "What do you mean? You can't get his eye open? What happened?"Changing directions, I entered the room to find a surprisingly cooperative patient with a grossly deformed face. The peri-orbital contusion prevented him from voluntarily opening his eye. So is that pre-septal or retro-orbital? We needed to take a look.Touching the upper lid, the immediate sensation of bubble pop burst forth under my gently retracting fingers. No proptosis or lateral canthotomy now. His vision was normal with no hyphema in the anterior chamber. The extraocular muscle was intact with no entrapment. A lateral subconjuctival hemorrhage likely meant a zygomaticomaxillary complex fracture.Yep, the red flags of extensive subcutaneous emphysema and a lateral subconjunctival hemorrhage were on the mark. He had a zygomaticomaxillary complex (ZMC) fracture. The arch bar artifact confirmed that our patient was not a novice to trauma.By whatever name you know ZMC fractures (tripod, tetrapod, malar, or trimalar), these have been thought to be the second most common facial fracture, second only to nasal fractures. These fractures include the zygomatic arch, the inferior and lateral orbital rim, and the anterior walls of the anterior and posterior sinus. Displaced fractures can cau...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs