Surgical treatment for greater sphenoid wing fracture (orbital blow-in fracture)

The authors present 2 patients with greater sphenoid wing fractures that we re treated surgically, This type of fracture is classified as a blow-in fra cture of the lateral orbital wall. The first patient was a 16-year-old boy who was involved in a motor vehicle accident. Computed tomography (CT) disc losed a medial displacement of the inner wall of the greater sphenoid wing of the left orbit. He was unconscious for 3 days. After he recovered consci ousness, he presented limited abduction of the left eye with diplopia in al l gaze directions and mild left proptosis. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing w ere removed via the lateral orbital approach. The patient had a good postop erative course with progressive improvement in eye movement over the next s everal weeks. The second patient was a 22-year-old man whose face was hit i n a fight. CT disclosed medial displacement of the inner wall of the greate r sphenoid wing of the left orbit, Although the patient also presented limi ted abduction of the left eye on admission, this symptom improved gradually . However, diplopia in all gaze directions and mild left proptosis did not improve. Therefore, the displaced inner wall of the greater sphenoid wing w as reduced via the lateral orbital approach. The patient showed a good post operative course with progressive improvement over the next several weeks, This type of orbital fracture, which is classified as an orbital blow-in fr acture, is relatively rare. This type of greater sphenoid wing fracture is caused by buckling of the orbital wall secondary to severe compression of t he orbital rim, Surgical treatment using the lateral orbital approach throu gh a hemicoronal skin incision afforded a wider operative field and better cosmetic result.