A 42-year-old man was hit by a car with a major complaint of facial pain. The patient had several facial fractures including: Le Fort I, naso-orbit-ethmoidal, anterior sinus wall and an exposed fracture of the orbit-zygomatic complex (OZC). The patient underwent to open reduction and internal fixation of facial fractures and enucleation of the left globe, however, evolved with postoperative infection and complications associated with, a so far unknown, type 2 diabetes. After secondary surgeries for removal infected bones and diabetes control, all injuries were fully healed, and the patient remained with major sequels.
In this case, we hypothesized a high-energy trauma resulting in multiple facial fractures, especially involving the OZC, dislocated the thick lateral wall of the orbit within the orbital cavity and reduced the orbital volume. This resulted in an exaggerated increase in intraorbital pressure, which exceeded the capacity of all anatomical protective mechanisms of the globe, and pushed the globe outwards, causing a complete avulsion.
Besides all anatomical structures to protect the globe, rarely high energy maxillofacial trauma can cause severe damage to the globe resulting in loss of vision and globe avulsion.
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