Nontraumatic orbital roof blowout fracture following nose blowing: illustrative case
- 1Department of Neurosurgery, Shingu Municipal Medical Center, Shingu, Wakayama.
- 2Department of Neurological Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan.
Abstract
Background
Orbital blowout fractures generally involve the floor or medial wall and usually result from blunt trauma. Nontraumatic orbital roof fractures associated with nose blowing are exceptionally rare.Observations
An 84-year-old man developed immediate left orbital swelling, epistaxis, diplopia, and impaired downgaze after forceful nose blowing. CT demonstrated fractures of the left medial orbital wall and orbital roof, with intracranial herniation of orbital tissue. MRI showed herniation of the superior rectus muscle and orbital fat through the roof defect and an adjacent inferior frontal lobe hematoma. During an extradural transcranial operation, herniated orbital fat was found to have penetrated the dura and adhered firmly to the frontal lobe. The adherent tissue was released, the dura and periorbita were repaired, and the orbital roof was reconstructed. Diplopia and downgaze limitation improved postoperatively.Lessons
An orbital roof fracture should be considered when orbital swelling and diplopia develop immediately after forceful nose blowing, even without trauma. Intracranial herniation and adhesion of orbital tissue may contribute to persistent ocular motility disturbance and may warrant surgical treatment. https://thejns.org/doi/abs/10.3171/CASE26847.
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BibTeX
@article{miyamoto2026nontraumatic,
title = {{Nontraumatic orbital roof blowout fracture following nose blowing: illustrative case}},
author = {Takanobu Miyamoto and Masaki Tomobuchi and Yoko Nakanishi and Yasuo Nakai and Takafumi Ishihara and Naoyuki Nakao},
journal = {Journal of neurosurgery. Case lessons},
year = {2026},
month = nov,
doi = {10.3171/case26847},
url = {https://europepmc.org/article/PMC/PMC13726440},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Nontraumatic orbital roof blowout fracture following nose blowing: illustrative case
AU - Takanobu Miyamoto
AU - Masaki Tomobuchi
AU - Yoko Nakanishi
AU - Yasuo Nakai
AU - Takafumi Ishihara
AU - Naoyuki Nakao
PY - 2026
DA - 2026/11/02
JO - Journal of neurosurgery. Case lessons
DO - 10.3171/case26847
UR - https://europepmc.org/article/PMC/PMC13726440
AB - Background Orbital blowout fractures generally involve the floor or medial wall and usually result from blunt trauma. Nontraumatic orbital roof fractures associated with nose blowing are exceptionally rare.Observations An 84-year-old man developed immediate left orbital swelling, epistaxis, diplopia, and impaired downgaze after forceful nose blowing. CT demonstrated fractures of the left medial orbital wall and orbital roof, with intracranial herniation of orbital tissue. MRI showed herniation of the superior rectus muscle and orbital fat through the roof defect and an adjacent inferior frontal lobe hematoma. During an extradural transcranial operation, herniated orbital fat was found to have penetrated the dura and adhered firmly to the frontal lobe. The adherent tissue was released, the dura and periorbita were repaired, and the orbital roof was reconstructed. Diplopia and downgaze limitation improved postoperatively.Lessons An orbital roof fracture should be considered when orbital swelling and diplopia develop immediately after forceful nose blowing, even without trauma. Intracranial herniation and adhesion of orbital tissue may contribute to persistent ocular motility disturbance and may warrant surgical treatment. https://thejns.org/doi/abs/10.3171/CASE26847.
SN - 2694-1902
ER -