A 64-year-old man was referred to our emergency department from a local hospital. He fell down from a 3-m stepladder while pruning branches of a tree. Brain computed tomographic (CT) scan revealed acute epidural hematoma in both frontal convexities (Figure 1), and he underwent craniotomy at the local hospital. On follow-up brain CT, an orbital roof fracture with a displaced bony fragment and hemorrhage was noticed in the left superior extraconal space. Thereafter, he was transferred to our department (Figure 2).
Initial brain computed tomography at the local hospital. Upper: axial view. Middle: coronal view. Lower: sagittal view. No definite fracture is seen on the left orbital roof. Parietal bone fractures are seen in the sagittal view.
Brain computed tomography after the first operation at the local hospital. Upper: axial view. Middle: coronal view. Lower: sagittal view. Epidural hematomas are seen on both anterior frontal convexities. A displaced orbital roof fracture segment is seen.
Upon examination, movement of the extraocular muscles was normal. He did not complain of diplopia or decreased sensation of the face. He also did not have nasal stuffiness. Exophthalmometry revealed the same findings for both eyes (18 mm/18 mm). Facial CT scan before the second operation revealed a displaced orbital roof fracture segment (Figure 3).
Facial computed tomography before the second operation: (a) axial view; (b) coronal view; (c) sagittal view; and (d) 3-dimensional reconstructive view. A displaced orbital roof fracture segment is seen.
Under general anesthesia, craniotomy was performed and the epidural hematoma was evacuated. The displaced bony fragment was removed from the left anterior cranial fossa, and the anterior skull base was reconstructed with a titanium mesh plate (Optimus neuroplate, 3D Mesh 50×50 mm; Osteonic, Seoul, Korea) (Figure 4).
Brain computed tomography after the second operation, axial view. A displaced orbital roof fracture segment has been removed, and the defect of the orbital floor was reconstructed with a titanium mesh plate.
ePlasty. 2020;20(e13) © 2020 Open Science Company