Orbit applied aspects

Orbital fractures:

Blowout fracture: A blow to orbital margins can lead to fracture of orbital walls due to thinnest nature
of floor and medial wall while orbital margins remain intact.

Medial wall injury can involve ethmoidal and sphenoidal sinuses.

Floor injury can involve maxillary sinus.

Injury can lead to intra orbital bleeding and then protrusion of eyeball (exophthalmos).

Orbital tumors

Sign: exophthalmos. These tumors can erode orbital walls and involve the associated sinuses.

Tumor can spread to middle cranial fossa through superior orbital fissure

Can spread to temporal and infra temporal fossa through inferior orbital fissure.

For operations, lateral wall is approached.

Nerve injuries

Oculomotor nerve injury:

Paralysis Resulting effect Unopposed action of healthy

muscle

Lecator palpebrae superioris Ptosis (drooping of eyelid) Orbicularis oculi

Sphincter pupillae Fully dilate, non- reactive pupil Dilator pupillae
Extraocular muscles except LR & Pupil abducted and downward LR & SO
SO (down & out)

Abducent nerve injury:

Paralysis Resulting effect Unopposed action of healthy

muscle

Lateral rectus Inability to abduct. Medial rectus

eyeball fully adducted
Blockage of vein and artery of retina:

Central artery of retina Central vein of retina

Old age disease, usually unilateral, results by As this vein drains into cavernous sinus, so can get
blockage from an embolus involved after cavernous sinus thrombosis.
Because these are end arteries, can lead to instant Slow, painless loss of vision
total blindness

Cranial fossa and meninges applied aspects

Pterion fracture
Lateral blow to skull can lead to fracture of pterion and injury to frontal branch of middle meningeal
artery (a reason for life threatening condition, extradural hematoma)

Location of pterion: two finger’s breadth above the zygomatic arch and one thumb breadth posterior to
frontal process of zygomatic bone.

Blunt trauma to head

Usually it results into separation of periosteal layer of dura matter from calvaria.

In cranial base, it is difficult to separate two layers.

Tentorial herniation
Herniation of temporal lobe from tentorial notch due to increased intra cranial pressure after tumor in
supratentorial compartments.

It can result into laceration of temporal lobe and compression of oculomotor nerve – paralysis of
extraocular muscles

Pituitary tumors
General symptoms

Enlarged sella turcica Optic nerve injury – bitemporal hemianopia

Third ventricle involvement – raised intracranial pressure

Hypothalamus involvement – hypothalamic syndrome

Specific symptoms

Hormonal effects

Congenital cutaneous naevi (port wine stain)

Abnormal formation of tiny blood vessels

Treatment of trigeminal neuralgia

Injection of alcohol in trigeminal ganglion

Dural headaches
As dura is pain sensitive, dural headache can result from

Scalp distention

Vessels dilataion

Infection or inflammation

Lumbar puncture to remove CSF

Hemorrhages
Extradural Subdural Subarachnoid
Arterial injury Venous injury Arterial origin
Middle meningeal artery Superior cerebral vein Arterial aneurysm
Initial loss of consciousness, then Hard blow but symptoms are late Symptoms of headache, stiff
lucid interval, then again coma neck appears