Computerized tomographic scan findings in facial fractures associated with blindness

Area of Science:

• Ophthalmology
• Neurosurgery
• Radiology

Background:

• Facial fractures are common injuries, and their association with visual impairment requires further investigation.
• Operative repair of facial fractures is a standard procedure, but potential complications like blindness need careful consideration.

Observation:

• A retrospective study of 379 patients undergoing facial fracture repair revealed that 6% developed blindness.
• Five patients with severe facial fractures (Le Fort II/III, frontal bone/sinus, zygoma, orbital floor) exhibited associated lesser sphenoid wing and optic canal fractures.
• One additional patient without a fracture experienced gradual blindness due to indirect optic nerve injury after frontal bone trauma.

Findings:

• Indirect optic nerve injuries, characterized by visual loss and afferent pupillary defect, were linked to fractures of the lesser sphenoid wing and optic canal in 5 patients.
• CT scans identified fractures of the lesser sphenoid wing and subdural hematoma of the optic nerve sheath as key findings.
• Sphenoethmoid sinus hemorrhage was associated with optic canal fractures in 31% of facial trauma cases.

Implications:

• This study highlights the critical association between specific facial fractures and the risk of blindness due to optic nerve injury.
• The findings underscore the importance of advanced imaging like CT scans in diagnosing optic canal fractures and associated injuries.
• Understanding these associations can guide surgical decision-making and inform the indications for optic nerve decompression to preserve vision.