case_images: PMC11834753_01
case_images: Eye movement and enophthalmos findings at the initial examination at our hospital.. (a) The left eye appears noticeably sunken in the frontal view. There is a movement restriction of the left eye when looking upward. (b) Results of the Hess test: the patient exhibits impaired upward movement of the left eye.. We obtained written consent from the patient to publish the photo in an open-access journal.
case_images: cureus-0017-00000077659-i01.jpg
case_images: PMC11834753_01_cureus-0017-00000077659-i01.jpg
case_images: FIG1
case_images: Hess screen test confirmed significant restrictions in ocular motility (Figure 1).
case_images: CT and MRI findings at the initial examination in our hospital (two months after the trauma).. (a) A coronal CT scan shows significant displacement of the orbital contents, including the inferior rectus muscle. Adhesion of the tissue around the inferior rectus muscle is suspected at the point indicated by the arrow. (b) A sagittal CT scan reveals an extensive orbital floor fracture extending both anteriorly and posteriorly. Additionally, maxillary sinusitis is observed. (c) Findings suggestive of acute inflammation due to odontogenic maxillary sinusitis (the arrow indicates the location). (d) MRI T2-weighted image showing inflammatory findings in the maxillary sinus, with a slightly high signal in the intraorbital fat.
case_images: cureus-0017-00000077659-i02.jpg
case_images: PMC11834753_01_cureus-0017-00000077659-i02.jpg
case_images: FIG2
case_images: CT and MRI imaging showed extensive orbital floor fracture with orbital herniation into the maxillary sinus and associated odontogenic maxillary sinusitis (Figure 2).
case_images: Intraoperative findings. The orbital floor was manipulated using a 70-degree endoscope through the lower eyelid.. (a) The maxillary sinus mucosa is edematous and prone to bleeding. (b) The orbital floor was manipulated using a 70-degree endoscope through the lower eyelid. The orbital floor bone and surrounding tissue of the inferior rectus muscle were dissected from the lower eyelid. Adhesions are indicated by the yellow arrow. (c) The tissue surrounding the inferior rectus muscle after dissection. The scar tissue marked by the yellow arrow has been released.. NLD: nasolacrimal duct; OF: orbital floor.
case_images: cureus-0017-00000077659-i03.jpg
case_images: PMC11834753_01_cureus-0017-00000077659-i03.jpg
case_images: FIG3
case_images: Intraoperatively, the maxillary sinus mucosa was severely edematous and prone to bleeding (Figure 3A). Adhesions between the tissue around the inferior rectus muscle and orbital floor were identified and sharply dissected (Figures 3B, 3C).
case_images: Postoperative findings of eye movement and enophthalmos.. (a) Significant improvement is observed in the left enophthalmos and the upward movement restriction of the left eye. (b) Results of the Hess test after surgery: the upward gaze limitation of the left eye has significantly improved.
case_images: cureus-0017-00000077659-i04.jpg
case_images: PMC11834753_01_cureus-0017-00000077659-i04.jpg
case_images: FIG4
case_images: Eye movement, diplopia, and enophthalmos showed improvement early after surgery, and sufficient repair was confirmed by CT (Figures 4, 5A, 5B).
case_images: Postoperative CT findings.. (a) A coronal CT scan shows that the orbital floor has been reconstructed, effectively containing the orbital contents within the orbit, as indicated by the yellow arrow. (b) A sagittal CT scan shows that the repair extends from the anterior to the posterior edge of the orbit, as indicated by the yellow arrow. (c) Odontogenic maxillary sinusitis improved following endoscopic sinus surgery and tooth extraction.
case_images: cureus-0017-00000077659-i05.jpg
case_images: PMC11834753_01_cureus-0017-00000077659-i05.jpg
case_images: FIG5
case_images: Eye movement, diplopia, and enophthalmos showed improvement early after surgery, and sufficient repair was confirmed by CT (Figures 4, 5A, 5B). The findings of sinusitis, including odontogenic maxillary sinusitis, also showed improvement (Figure 5C).