J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):428-434. 10.5125/jkaoms.2020.46.6.428.

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

• Brasileiro BF
• Van Sickels JE
• Cunningham LL

• KMID: 2510019
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.428

Abstract

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

Keyword

Orbital fractures; Facial injuries; Oculocardiac reflex

Figure

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  Fig. 1 Preoperative clinical examination of the upward gaze, demonstrating vertical restriction in ocular motility after an orbital floor blowout fracture on the right side.

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  Fig. 2 Preoperative coronal computed tomography (coronal view) showing right floor linear discontinuity with entrapment of orbital contents (white arrow) into the maxillary sinus (tear drop sign).

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  Fig. 3 Intraoperative view of the right orbit with linear floor blowout fracture and trapdoor defect. Entrapment of the inferior rectus muscle and orbital fat can be observed.

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  Fig. 4 Intraoperative view of orbital floor reconstruction with a resorbable orbital plate after incarcerated soft tissue release and floor fracture reduction.

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  Fig. 5 Immediate postoperative clinical examination of the upward gaze, exhibiting normal vertical ocular motility after management of the orbital floor blowout fracture on the right side.

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  Fig. 6 Graphic illustration of the oculocardiac reflex pathway from afferent sensory nerve endings of the trigeminal nerve (ciliary nerves) to efferent branches of the vagus nerve in the heart (sinoatrial node).

Reference

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