After being involved in a street altercation, a 30-year-old guy arrives at the emergency department with left eye discomfort. He was hit in the left eye with a fist and has since had discomfort and diplopia. Previous medical history is significant for two prior gunshot wounds. The patient does not smoke cigarettes but has a history of excessive alcohol use and marijuana usage. There is substantial soft tissue edema around the left eye on inspection. Although visual acuity is adequate, extraocular movement in the left eye is restricted. Normal pupillary reflexes exist. The picture below depicts a Coronal CT scan of the orbits. The orbital contents of this patient are most likely to herniate into which of the following sites?

Question

After being involved in a street altercation, a 30-year-old guy arrives at the emergency department with left eye discomfort. He was hit in the left eye with a fist and has since had discomfort and diplopia. Previous medical history is significant for two prior gunshot wounds. The patient does not smoke cigarettes but has a history of excessive alcohol use and marijuana usage. There is substantial soft tissue edema around the left eye on inspection. Although visual acuity is adequate, extraocular movement in the left eye is restricted. Normal pupillary reflexes exist. The picture below depicts a Coronal CT scan of the orbits.  The orbital contents of this patient are most likely to herniate into which of the following sites?

Quizplus · Accepted Answer

Eductional Objective: The orbit is bounded superiorly by the thick orbital plate of the frontal bone and laterally by the thick bone of the zygoma and larger and lesser sphenoid wings. In contrast, the orbital floor is made up of a relatively thin layer of bone that separates the orbit from the air-filled maxillary sinus. Similarly, the orbit's medial wall is made up of thin ethmoid and lacrimal bones that divide it from the ethmoid air cells.
Blunt trauma to the eye creates a quick rise in pressure that, in most cases, does not rupture the globe but is carried posteriorly into the orbit. Fractures are most prevalent in the orbit's weakest plates of bone, the medial and inferior walls. Fracture is usually visible on radiographic imaging, and Fracture is typically evident on radiographic imaging, and fluid (eg, blood) or herniation of the orbital contents can often be visualized in the adjacent normally air-filled sinuses.

After Being Involved in a Street Altercation, a 30-Year-Old Guy