Closed head injury combined with orbital blowout fracture and displacement of the eyeball into the maxillary sinus in a 14-year-old boy: a case report.

BACKGROUND: Trauma-induced orbital blowout fracture (OBF) with eyeball displacement into the maxillary sinus is rare. CASE PRESENTATION: We present the case of a 14-year-old with a closed head injury, OBF, and displacement of the eyeball into the maxillary sinus following a car accident. A prompt transconjunctival access surgery was performed for eyeball repositioning and orbital reconstruction in a single session, mitigating anaesthesia-related risks associated with multiple surgeries. At the 12-month follow-up, his visual acuity was 20/200. Despite limited eye movement and optic nerve atrophy, overall satisfaction with the ocular appearance was achieved. CONCLUSIONS: This report offers novel insights into the mechanisms of OBF occurrence and the development of postoperative complications.

Subcutaneous emphysema and pneumomediastinum following orbital blowout pathological fracture in a cat with nasal lymphoma: a case report.

BACKGROUND: Subcutaneous emphysema and pneumomediastinum are rare complications associated with orbital blowout pathological fracture. CASE PRESENTATION: A 7-year old, castrated male Abbysinian cat presented with anorexia, lethargy, nausea, eyelid swelling, nasal discharge, and sneezing. Based on the clinical and diagnostic work-up, the cat was diagnosed with T cell high-grade nasal lymphoma associated with orbital pathological fracture due to the tumour invasion. After chemotherapy, the cat showed massive subcutaneous emphysema from frontal region to abdomen and pneumomediastinum due to orbital blowout pathological fracture. As the nasal mass decreased in volume; the air had moved from the maxillary sinus to the subcutaneous region and the mediastinum through fascial planes in the head and neck region. CONCLUSIONS: This is a first case report of a massive subcutaneous emphysema and pneumomediastinum due to an orbital blowout pathological fracture following chemotherapy in feline nasal lymphoma in veterinary medicine.

Bilateral pneumatic blowout fractures in a patient with silent sinus syndrome while diving.

A 37-year-old scuba diver developed sudden severe headache, mid-facial pressure/pain and diplopia while diving. Upon examination, he had signs and symptoms consistent with silent sinus syndrome (SSS), including bilateral enophthalmos, hypoglobus, and diplopia/strabismus in conjunction with CT findings of occluded maxillary sinus ostia, atrophic/collapsed maxillary sinuses, and bilateral orbital floor fractures with fat herniation. As there was no history of trauma or chronic sinusitis, this rare case of bilateral SSS was deemed the cause of the spontaneous fractures (i.e. barotrauma secondary to a lack of equalization to ambient surrounding pressure). Transconjunctival repair of the fractures was successful and maxillary sinus antrostomies re-established aeration of the sinuses. We present this case and its management, as well as review the literature concerning sinus barotrauma as a result of diving and SSS. There have been no reports of orbital fractures primarily caused by scuba diving, nor secondarily from diving with the rare entity, SSS.

Outcome of Precontoured Titanium Mesh in the Reconstruction of Orbital Blowout Fractures.

Background Orbital blowout fractures are peculiar injuries causing disruption of both ocular function and symmetry. We present our experience with the use of a precontoured titanium mesh in orbital blowout fractures. Methods A retrospective study of patients undergoing correction of orbital blowout fractures with a precontoured titanium mesh was done at a tertiary care center in Mumbai. Data regarding demographics and pre- and postoperative clinical and radiological attributes were retrieved and compared. Results A total of 21 patients (19 males and 2 females) underwent correction of blowout fractures with a precontoured titanium mesh. The follow-up period ranged from 6 to 10 months. Road traffic accident (76%) was the most common etiology. Twenty (95%) patients had impure blowout fractures and 1 (5%) patient had a pure blowout. The orbital floor was most commonly fractured (16 [76%]). Associated fractures of the zygomaticomaxillary complex were found in 71% of patients. All patients were operated on within 3 weeks of trauma. A comparison of the operated and uninjured sides on coronal views of computed tomography (CT) scan in nine patients by Photopea application revealed a correction of the increased cross-sectional area in all cases. Enophthalmos was completely corrected in 94% patients, while 92% patients had complete correction of diplopia. One patient with a comminuted zygomatic fracture had persistent diplopia and mild enophthalmos. Infraorbital paresthesia persisted in 58% patients at 6 months of follow-up. No significant postoperative complications were noted. Conclusion The precontoured titanium mesh restores orbital wall anatomy and is safe, quick, fairly easy, and reproducible with a shorter learning curve. With proper patient selection and execution, prefabricated titanium mesh can serve as an excellent reconstructive option in blowout fractures of the orbit.

ORBITAL BLOWOUT FRACTURES: A RETROSPECTIVE STUDY WITH LITERATURE REVIEW.

Blowout fractures of the orbit are relatively common injuries of the viscerocranium. However, there is still no general consensus on the optimal timing and method of treatment. This article gives a comprehensive review of the pathology of the fracture, process of diagnosis, management and follow-up, including results of a retrospective study done in the Department of Maxillofacial and Oral Surgery, Dubrava University Hospital, Zagreb, in which we collected and analyzed medical records of 91 patients treated for blowout fractures in our institution over a period of three years. Our study showed that the patients admitted to our department more than 48 hours from the injury were more than 4 times likely to develop a complication that would require additional treatment. In other words, of our 91 patients, those admitted to our department in the first 48 hours from the injury had a more than 4 times lower rate of complications, likely due to early recognition of the injury with early intravenous antibiotic and corticosteroid administration, multidisciplinary treatment, and early recognition of candidates for emergency and early surgical treatment. The results of our study show the importance of treating blowout fractures in a tertiary care facility with expertise on the subject.

Effects of orthoptic training for residual diplopia after surgical repair of blowout fractures.

PURPOSE: To investigate the effects of orthoptic training for residual diplopia after blowout fracture (BOF) surgery. METHODS: We retrospectively reviewed the medical records of 14 (average age, 22.9 ± 13.1 years) patients with residual diplopia, who had undergone orthoptic training after BOF surgery at the Department of Ophthalmology, Kindai University Hospital, between August 2013 and September 2019. The orthoptic training included exercises for eye movement, convergence, and fusional area expansion. We assessed the training effects by scoring patients' Hess screen (Hess) test results and fields of binocular single vision (BSV). The scores obtained before/after surgery and after training were compared. We also investigated the factors that influenced patients' BSV scores after training. p < 0.05 was considered statistically significant. RESULTS: The respective pre- and postoperative and after-training average scores were 7.0 ± 5.3, 5.4 ± 4.3, and 2.5 ± 3.2 points for Hess and 50.0 ± 41.3, 48.2 ± 35.9, and 89.4 ± 14.0 points for BSV. Neither Hess nor BSV score showed a significant difference before and after surgery (p > 0.05, the Steel-Dwass test). Compared to the postoperative (i.e., before training) scores, both Hess and BSV scores significantly improved after training (p < 0.05 for Hess, p < 0.01 for BSV; the Steel-Dwass test). CONCLUSION: Orthoptic training appeared effective in resolving residual diplopia after BOF surgery by improving patients' ocular motility and expanding the BSV field.

Correlation between surgical timing and postoperative ocular motility in orbital blowout fractures.

PURPOSE: The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. METHODS: This was a retrospective study of 191 patients that underwent surgical repair for unilateral orbital fractures. All patients included in the study had symptomatic diplopia from the fracture. Patients were classified into one of three groups according to the time of surgery after injury: (1) Early (within 14 days of surgery), (2) intermediate (between 15 and 30 days), and (3) late (greater than 30 days). Ocular motility was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the Hess area ratio (HAR%). RESULTS: Surgery was conducted at a mean of 24.7 ± 45.0 days (range: 1-283 days) postinjury. There were 120 patients in the early surgery group (surgery at 6.8 ± 3.8 days), 38 in the intermediate surgery group (20.7 ± 4.1 days), and 33 in the late surgery group (95.1 ± 75.0 days). Overall the HAR% improved significantly from a mean of 74.2% preoperatively to 90.8% at 6 months postoperatively (p < 0.01). In the early and intermediate groups, the postoperative HAR% improved significantly with all fracture regions (orbital floor, medial wall, and combined orbital medial wall and floor) (p < 0.05). However, in the late groups, the postoperative HAR% only improved significantly with orbital floor fractures. CONCLUSION: Pre- and postoperative the HAR% give objective evidence of ocular motility improvement with early orbital floor fracture repair surgery. However, observation can be deployed, as a significant improvement in ocular motility can also be achieved with reconstructive surgery conducted 30 days or more after depressed floor-fragment fractures. Early intervention should be prioritized for symptomatic medial wall fractures, as late surgery does not improve motility.

Bioactive Composite for Orbital Floor Repair and Regeneration.

In the maxillofacial area, specifically the orbital floor, injuries can cause bone deformities in the head and face that are difficult to repair or regenerate. Treatment methodologies include use of polymers, metal, ceramics on their own and in combinations mainly for repair purposes, but little attention has been paid to identify suitable materials for orbital floor regeneration. Polyurethane (PU) and hydroxyapatite (HA) micro- or nano- sized with different percentages (25%, 40% & 60%) were used to fabricate bioactive tissue engineering (TE) scaffolds using solvent casting and particulate leaching methods. Mechanical and physical characterisation of TE scaffolds was investigated by tensile tests and SEM respectively. Chemical and structural properties of PU and PU/HA scaffolds were evaluated by infrared (IR) spectroscopy and Surface properties of the bioactive scaffold were analysed using attenuated total reflectance (ATR) sampling accessory coupled with IR. Cell viability, collagen formed, VEGF protein amount and vascularisation of bioactive TE scaffold were studied. IR characterisation confirmed the integration of HA in composite scaffolds, while ATR confirmed the significant amount of HA present at the top surface of the scaffold, which was a primary objective. The SEM images confirmed the pores' interconnectivity. Increasing the content of HA up to 40% led to an improvement in mechanical properties, and the incorporation of nano-HA was more promising than that of micro-HA. Cell viability assays (using MG63) confirmed biocompatibility and CAM assays confirmed vascularization, demonstrating that HA enhances vascularization. These properties make the resulting biomaterials very useful for orbital floor repair and regeneration.

Blowout fracture-associated orbital cellulitis progressing to panophthalmitis: a case report.

BACKGROUND: Parvimonas micra is known as a causative agent of chronic periodontal disease. This Gram-positive obligate anaerobic coccus was cultured from the ocular surface of blowout fracture-related orbital cellulitis progressing to panophthalmitis. CASE PRESENTATION: The patient was a woman in her fifties who had panic disorder and subsequently was a victim of domestic violence. These factors led to delayed consultation. At the initial visit to an ophthalmologist, the ocular surface of the right eye was covered with pus. Swelling of the upper and lower eyelids prevented the eyelid from closing and exophthalmos, severe corneal ulcer, panophthalmitis, and no light perception were observed. Head computed tomography revealed an old blowout fracture and chronic sinusitis with orbital cellulitis. P. micra were isolated from culture of pus samples from the sinus and from the ocular surface. CONCLUSIONS: There is a possibility that P. micra invaded the orbit via the fragile bony site and caused orbital cellulitis, severe corneal ulcer, and panophthalmitis that required enucleation. In cases of coexisting old blowout fracture and chronic sinusitis, the chronic sinusitis should be treated as quickly as possible.

White-eyed blowout fracture with muscle entrapment misdiagnosed as increased intracranial pressure: An important clinical lesson.

Patients with white-eyed blowout fracture with muscle entrapment in the pediatric population may be misdiagnosed as increased intracranial pressure (ICP) due to the similarity in presenting symptoms. A delay in the correct diagnosis can lead to permanent sequelae including diplopia, permanent loss of vision, and death. In this case report we discuss the treatment of a male pediatric patient who presented in the ED with nausea, confusion, and restricted eye gaze. He was misdiagnosed with increased intracranial pressure and was admitted to the PICU. Subsequent consultation by ophthalmology allowed for the correct diagnosis of a trapdoor fracture. The patient was taken to the OR for emergent orbitotomy with reduction of the fracture and release of the entrapped muscle. Symptoms of white-eyed orbital blowout fractures with muscle entrapment easily mimic symptoms of head trauma with increased ICP. Misdiagnosis of trapdoor orbital fractures with entrapment can be avoided by ordering and critically reviewing an orbital CT and requesting an ophthalmologic consultation in the ED to evaluate extraocular movement. This report should help to increase awareness of symptoms of white-eyed orbital blowout fractures with muscle entrapment, prevent confusion with elevated ICP, and assist accurate and timely diagnosis in the ED to arrange appropriate management and surgical intervention to ensure best outcomes.

Radiological findings of orbital blowout fractures: a review.

Purpose: To summarize the radiological findings in patients with orbital blowout fractures. Methods: We reviewed the published literature on radiological findings of orbital blowout fractures that were searched on PubMed and included our own radiologic findings on patients with orbital blowout fractures that were seen at our hospital. Results: Radiologic examination reveals a variety of findings in each case. However, common radiological findings of orbital blowout fractures include comminuted/unhinged, hinged, and linear fractures. These fractures are usually located in the orbital floor medial to the infraorbital nerve and in the medial orbital wall. Orbital fat is frequently herniated in the paranasal sinus or incarcerated at the fracture site. Orbital emphysema and haematoma sometimes occur as complications. Conclusions: This review will provide surgeons with a better understanding of various radiological findings, which could be helpful in the management of patients with orbital blowout fracture.

Association between pre- and intraorbital soft tissue volumes and the risk of orbital blowout fractures using CT-based volumetric measurements.

Orbital blowout fractures result from trauma which breaks the bony orbital wall while sparing the rim. Previous research into fracture mechanism has focused on bony anatomy. This study evaluates the role of preorbital and intraorbital soft tissue volume in fracture risk. A retrospective case-control study was conducted on 51 cases of adults with unilateral orbital blowout fracture, matched to 51 controls who had experienced orbital trauma by comparable mechanisms without sustaining a fracture. Axial Computed Tomography (CT) images with orbital fine cuts were assessed on a 3D post-processing workstation to measure the volume of the pre- and intraorbital soft tissues, then compared between the two groups using Mann-Whitney U analysis. In the case group, there were 40 males (78%), injured by assault (66%), fall (12%), motor vehicle collision (10%), or other cause (12%). The control group included 33 males (65%), injured by assault (55%), fall (22%), motor vehicle (4%), or other cause (20%). There was no significant difference in mechanism rates between case and control groups. Median preorbital volumes were 12.5 cm3 in the case group and14.1 cm3 in controls (p = 0.02). Median intraorbital volumes were 24.4 cm3 in the case group and 25.9 cm3 in controls (p = 0.003). CT volumetric analysis shows that patients who sustained blowout fractures have lower preorbital and intraorbital soft tissue volume than those who did not fracture. This underscores the significant role that soft tissues play in dissipating impact forces, both anterior to the orbital rim and within the orbit itself.

Complete inferior rectus muscle transection secondary to orbital blowout fracture.

Complete extraocular muscle transection is uncommon in the setting of blunt trauma. We report a case of a 53-year-old male that developed diplopia after hitting his face directly on a concrete slab after a fall. On examination, he had a right hypertropia with a complete infraduction deficit. A CT scan of the face showed an orbital floor blowout fracture with complete inferior rectus transection. On surgical exploration, the distal and proximal ends of the muscle were identified and sutured together, and the floor fracture was repaired. At his post-operative visits, the patient had a persistent infraduction deficit, but subjectively had improved diplopia.

Clinical effects of 3-D printing-assisted personalized reconstructive surgery for blowout orbital fractures.

PURPOSE: One of the key challenges during orbital fracture reconstructive surgery, due to the complex anatomy of the orbit, is shaping and trimming the precise contour of the implants. The objectives of this study were to describe and evaluate the use of a three-dimensional (3-D) printing technique for personalized reconstructive surgery for repairing orbital fractures. METHODS: A total of 29 cases which had 3-D technique-assisted surgical reconstruction, and 27 cases which had traditional surgery, were retrospectively analyzed. Preoperative and postoperative CT images were measured using MIMICS software, and the contour of the fracture zone and the Medpor-titanium implant were analyzed and compared. The surgical duration was also compared between the two groups. RESULTS: There were statistically significant differences in the maximum width, depth and area between fracture zone and implant between the two groups, with the absolute value in the 3-D group markedly lower as compared to the control group. In addition, the difference in the medial-inferior wall angle between the surgical eye and healthy eye was also statistically significant between the groups. The average surgical duration in the 3-D group was substantially shorter than in the control group. Additionally, the postoperative clinical evaluation in the 3-D group was superior to that of the control group. CONCLUSION: The 3-D printing technique is of great value for predicting the precise fracture zone before, and during, personalized surgery, and can help surgeons achieve accurate anatomical reconstruction for repairs of blowout orbital fractures. Moreover, the simulated bone template produced by 3-D printing models allows for "true-to-original" orbital reconstruction, which can shorten the surgical duration and improve the accuracy and safety of the operation.

Effect of navigation endoscopy combined with three-dimensional printing technology in the treatment of orbital blowout fractures.

AIM: To explore the combined application of surgical navigation nasal endoscopy (NNE) and three-dimensional printing technology (3DPT) for the adjunctive treatment of orbital blowout fractures (OBF). METHODS: Retrospective analysis was conducted on the data of patients with OBF who underwent surgical treatment at the Affiliated Eye Hospital of Nanchang University between July 2012 and November 2022. The control group consisted of patients who received traditional surgical treatment (n=43), while the new surgical group (n=52) consisted of patients who received NNE with 3DPT. The difference in therapeutic effects between the two groups was evaluated by comparing the duration of the operation, best corrected visual acuity (BCVA), enophthalmos difference, recovery rate of eye movement disorder, recovery rate of diplopia, and incidence of postoperative complications. RESULTS: The study included 95 cases (95 eyes), with 63 men and 32 women. The patients' age ranged from 5 to 67y (35.21±15.75y). The new surgical group and the control group exhibited no statistically significant differences in the duration of the operation, BCVA and enophthalmos difference. The recovery rates of diplopia in the new surgical group were significantly higher than those in the control group at 1mo [OR=0.03, 95%CI (0.01-0.15), P<0.0000] and 3mo [OR=0.11, 95%CI (0.03-0.36), P<0.0000] post-operation. Additionally, the recovery rates of eye movement disorders at 1 and 3mo after surgery were OR=0.08, 95%CI (0.03-0.24), P<0.0000; and OR=0.01, 95%CI (0.00-0.18), P<0.0000. The incidence of postoperative complications was lower in the new surgical group compared to the control group [OR=4.86, 95%CI (0.95-24.78), P<0.05]. CONCLUSION: The combination of NNE and 3DPT can shorten the recovery time of diplopia and eye movement disorder in patients with OBF.

Are Age and Trauma Mechanism Associated with Volume Change in the Fractures of the Bony Orbit?

Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient's age is associated with increased volume change in fractures of the bony orbit.

Biomechanical analysis of an absorbable material for treating fractures of the inferior orbital wall.

AIM: To investigate the biomechanical properties and practical application of absorbable materials in orbital fracture repair. METHODS: The three-dimensional (3D) model of orbital blowout fractures was reconstructed using Mimics21.0 software. The repair guide plate model for inferior orbital wall fracture was designed using 3-matic13.0 and Geomagic wrap 21.0 software. The finite element model of orbital blowout fracture and absorbable repair plate was established using 3-matic13.0 and ANSYS Workbench 21.0 software. The mechanical response of absorbable plates, with thicknesses of 0.6 and 1.2 mm, was modeled after their placement in the orbit. Two patients with inferior orbital wall fractures volunteered to receive single-layer and double-layer absorbable plates combined with 3D printing technology to facilitate surgical treatment of orbital wall fractures. RESULTS: The finite element models of orbital blowout fracture and absorbable plate were successfully established. Finite element analysis (FEA) showed that when the Young's modulus of the absorbable plate decreases to 3.15 MPa, the repair material with a thickness of 0.6 mm was influenced by the gravitational forces of the orbital contents, resulting in a maximum total deformation of approximately 3.3 mm. Conversely, when the absorbable plate was 1.2 mm thick, the overall maximum total deformation was around 0.4 mm. The half-year follow-up results of the clinical cases confirmed that the absorbable plate with a thickness of 1.2 mm had smaller maximum total deformation and better clinical efficacy. CONCLUSION: The biomechanical analysis observations in this study are largely consistent with the clinical situation. The use of double-layer absorbable plates in conjunction with 3D printing technology is recommended to support surgical treatment of infraorbital wall blowout fractures.

Diagnostic pitfalls in pediatric orbital entrapment fractures.

Prompt diagnosis and management of orbital entrapment fractures in the pediatric patient have been advocated. This retrospective study analyzed a cohort of orbital entrapment fractures in pediatric patients with regard to diagnostic pitfalls, treatment and outcomes in a Level I trauma center in Germany. Based on medical records and radiological imaging, patients under the age of 18 years who presented with orbital fractures during 2009-2021 were analyzed. Overall, 125 patients presented with orbital fractures, of whom 29 patients (23.2%) had orbital entrapment fractures. The majority of patients presented with monocle hematoma (n = 23), diplopia (n = 20), and/or restricted extraocular eye movement (n = 14). While all patients with orbital entrapment fractures underwent three-dimensional imaging, 10 radiological reports (34.5%) did not include findings on orbital entrapment fractures. All patients underwent surgical exploration in less than 24 h. In 12 patients, clinical symptoms such as diplopia and restricted ocular elevation were documented upon postoperative evaluation before discharge. Considering the significant proportion of orbital entrapment fractures that are not noted on radiological imaging, prompt clinical examination should be initiated in pediatric patients at risk for orbital fractures. Urgent surgical intervention should be recommended in entrapment fractures.

Intelligent surgical planning for automatic reconstruction of orbital blowout fracture using a prior adversarial generative network.

Orbital blowout fracture (OBF) is a disease that can result in herniation of orbital soft tissue, enophthalmos, and even severe visual dysfunction. Given the complex and diverse types of orbital wall fractures, reconstructing the orbital wall presents a significant challenge in OBF repair surgery. Accurate surgical planning is crucial in addressing this issue. However, there is currently a lack of efficient and precise surgical planning methods. Therefore, we propose an intelligent surgical planning method for automatic OBF reconstruction based on a prior adversarial generative network (GAN). Firstly, an automatic generation method of symmetric prior anatomical knowledge (SPAK) based on spatial transformation is proposed to guide the reconstruction of fractured orbital wall. Secondly, a reconstruction network based on SPAK-guided GAN is proposed to achieve accurate and automatic reconstruction of fractured orbital wall. Building upon this, a new surgical planning workflow based on the proposed reconstruction network and 3D Slicer software is developed to simplify the operational steps. Finally, the proposed surgical planning method is successfully applied in OBF repair surgery, verifying its reliability. Experimental results demonstrate that the proposed reconstruction network achieves relatively accurate automatic reconstruction of the orbital wall, with an average DSC of 92.35 ± 2.13% and a 95% Hausdorff distance of 0.59 ± 0.23 mm, markedly outperforming the compared state-of-the-art networks. Additionally, the proposed surgical planning workflow reduces the traditional planning time from an average of 25 min and 17.8 s to just 1 min and 35.1 s, greatly enhancing planning efficiency. In the future, the proposed surgical planning method will have good application prospects in OBF repair surgery.

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut.

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.