Facial Trauma and Orbital Fracture

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

View All Posts

About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

View All Posts

Question: I had trauma to my face and am bruised around my eye but my vision is normal. Does this mean I don’t have an orbital fracture?

Orbital fractures or fractures of the bones that comprise they eye-ball socket are exceedingly common, especially following facial trauma to the areas of the eye or cheekbone. Because of initial swelling and the location of the orbital bones, it is not easy for patients to determine if they have fractured these bones. Symptoms of a fracture are not always noticeable and are sometimes absent altogether.

Case Report

A 51-year-old male was playing basketball when he was elbowed in the side of the face. He immediately noticed a crunch sound and had a depression on the side of his cheek. His exam showed a depression of the left cheek. He had no double vision, pain with eye movement, or change in his vision. At this point a Zygomatico-maxillary complex (ZMC) fracture was suspected. A CT scan was obtained to determine the extent of the fracture. The CT scan revealed that the floor of the orbit had been pushed into the orbit. It had come within millimeters of the eye ball.



Figures 1 and 2: The top 2 figures show the ZMC fracture on a CT scan with 3-D reconstruction


Figure 3: This figure shows the floor of the orbit being pushed up in to the orbit and nearly hitting the eyeball

This case demonstrates that normal vision or the absence of obvious symptoms does not mean that you do not have an orbital fracture. Although it is true that most patients suffering from a blow out fracture of the orbit exhibit some degree of vision changes, such as double vision, it is possible to have normal vision with this type of a fracture. Therefore, if you have sustained trauma to your face, you should promptly seek evaluation from a facial trauma specialist to ensure there is no serious fracture.

To learn more about Dr. Hootan Zandifar and nasal fracture repair, please visit www.FacialTraumaMD.com.