Untreated 'blow-in' fracture of the orbital floor causing a mucocele: report of an unusual late complication.
BACKGROUND
Several severe complications have been described with blow-in fractures. Therefore, immediate surgical treatment of these fractures has been recommended. To date, there is only minimal knowledge on long-term complications of blow-in fractures that have remained untreated. The present case report describes a late complication of an untreated blow-in fracture of the orbital floor.


METHODS
A 37-year-old male was involved in a car accident 16 years before. At that time, a non-dislocated midfacial fracture was diagnosed and remained untreated because of the lack of clinical symptoms. Four months before surgery an exophthalmos of the left globe began to develop. CT examination revealed a consolidated blow-in fracture of the left orbital floor and an opaque mass around the dislocated bony fragments. By an infraorbital approach the bony fragments and the surrounding mass were removed. Histological examination of the removed material revealed a cystic structure lined with respiratory epithelium. Therefore, the diagnosis 'post-traumatic mucocele in the orbit caused by dislocated respiratory epithelium from the maxillary sinus' was made.


CONCLUSIONS
Even if blow-in fractures do not cause complications immediately after trauma, late complications like mucoceles can occur after several symptom-free years. Therefore, early reconstruction should be intended even in asymptomatic cases of blow-in fractures with minimal displacement of the bony fragments.
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany. emeka.nkenke@mkg.imed.uni-erlangen.de
Emeka
E
Nkenke
Kerstin
K
Amann
Tobias
T
Maier
Michaela
M
Benz
Manuel
M
Kramer
Gerd
G
Haeusler
Stefanie
S
Benz
Joerg
J
Wiltfang
Eleftherios G
EG
Vairaktaris
Friedrich Wilhelm
FW
Neukam
Leonhard
L
Holbach
D000063:Accidents, Traffic; D000328:Adult; D005094:Exophthalmos / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D009078:Mucocele / Q000209:etiology* / Q000601:surgery; D009917:Orbital Fractures / Q000150:complications* / Q000601:surgery