Spontaneous Repositioning of a Traumatic Intraorbital Encephalocele

Fractures of the orbital roof are relatively rare facial fractures that are often caused by high-energy trauma and are frequently seen in combination with intracranial injury and other facial fractures. Surgical reconstruction should be considered in cases with threatened visual function, significant displacement of fracture fragments, dural laceration, or additional facial fractures requiring repositioning. A rare complication of an orbital roof fracture, described in only a few case reports, is a traumatic intraorbital encephalocele (TIOE). This occurs when intracranial swelling disrupts the equilibrium between intracranial pressure (ICP) and intraorbital pressure, causing downward pressure and herniation of brain tissue through the fracture in the orbital roof. This can lead to compression and dysfunction of intraorbital structures, such as cranial nerves III, IV, and VI, which enter the orbit through the superior orbital fissure. The treatment of a TIOE requires a multidisciplinary approach involving neurosurgery, oral and maxillofacial surgery, and ophthalmology. In this article, the case of a 23-year-old male with extensive facial fractures after a motor vehicle collision is presented. Progressive displacement of the left orbital roof is observed as a TIOE develops in the early post-trauma phase. Remarkably, spontaneous repositioning of the orbital roof and reduction of the TIOE occurred over the following weeks under conservative management as intracranial swelling subsided, followed by remodeling.