Classification of Orbital Floor Fracture Patterns Associated With Inferior Rectus Muscle Entrapment

Area of Science:

• Ophthalmology
• Plastic Surgery
• Radiology

Background:

• Orbital floor fractures can lead to inferior rectus muscle entrapment, causing permanent diplopia, particularly in pediatric patients.
• Literature on adult entrapment is limited, necessitating further investigation into its clinical and radiologic presentations.

Purpose of the Study:

• To discuss the clinical and radiologic spectrum of inferior rectus muscle entrapment in adults.
• To propose a novel classification system for orbital floor fractures associated with adult entrapment, based on bone and soft tissue interactions.

Main Methods:

• A case series of three adult patients with isolated orbital floor fractures and inferior rectus muscle entrapment was reviewed.
• A systematic literature review on inferior rectus entrapment was conducted.
• A classification system was developed based on imaging findings (CT) from the case series and literature.

Main Results:

• Three adult patients presented with comminuted orbital floor fractures and evidence of inferior rectus muscle entrapment.
• Surgical intervention within 24 hours resulted in the restoration of baseline gaze in all patients.
• The study identified three distinct patterns of orbital floor fractures associated with inferior rectus muscle entrapment.

Conclusions:

• A new classification system for adult orbital floor fractures with inferior rectus muscle entrapment is proposed.
• Comminuted fractures are the most common pattern associated with adult entrapment.
• Permanent inferior rectus muscle injury due to ischemia is less likely in adults compared to pediatric patients.