A case of isolated blowout fracture of the orbital roof, trapdoor type, repaired using the transpalpebral approach

Abstract

An extremely rare case of an isolated fracture of the orbital roof caused only by an eye contusion and a simultaneous blowout fracture, trapdoor type, which was operated on using the transpalpebral supraorbital rim approach was reported herein. The patient was a 35-yearold male who fell off the surfboard into the sea with the fin hitting hard the patient’s right eye. The patient had right ptosis, pain on looking upwards, and forehead paralysis. No bruises on the head or face other than the lower eyelid were noted. The orbital computed tomography scan showed that only the orbital roof was fractured, the bone fragments cranially deviated, and the orbital fat was incarcerated in the fracture site. The patient underwent surgery using the transpalpebral supraorbital rim approach on day 14 postinjury. The fracture was of the trapdoor type, and the orbital fat, levator palpebrae superioris muscle, and supraorbital nerve were strangulated at the fracture site. Ptosis and eye movement disorder quickly improved postoperatively. Isolated orbital roof blowout fracture, trapdoor type, is a rare condition, and the fracture can be repaired using the transpalpebral approach in the absence of intracranial lesions and extensive bony deviation.