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Anatomy

Head and Neck

Question 163 of 190

A 29 year old woman presents to ED with a head injury following a climbing accident. Imaging shows that she has fractured the optic canal. Which of the following structures are most likely injured:

x ✓ Optic nerve and superior ophthalmic vein 11%
x ✓ Optic nerve and ophthalmic nerve 6%
x ✓ Oculomotor, trochlear and abducens nerve 5%
x ✓ Superior and inferior ophthalmic vein 1%
x ✓ Optic nerve and ophthalmic artery 76%

Answer:

The optic nerve and the ophthalmic artery enter the orbit through the optic canal. The trochlear, oculomotor, abducens and ophthalmic nerves and the superior ophthalmic vein enter the orbit through the superior orbital fissure. The inferior ophthalmic vein enters the orbit through the inferior orbital fissure.

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Bony Orbit

The bony orbit is formed from seven bones; the maxilla, zygomatic, frontal, ethmoid, lacrimal, sphenoid, and palatine bones.

Bones of the Orbit. (Image by OpenStax College [CC BY 3.0], via Wikimedia Commons)

Together they give the bony orbit the shape of a pyramid, with its apex extending in a posteromedial direction to become the optic foramen and the wide base extending anteriorly onto the face as the orbital rim.

Orbital Rim

The orbital rim is formed

superiorly by the frontal bone
medially by the frontal process of the maxilla
inferiorly by the zygomatic process of the maxilla and the zygomatic bone
laterally by the zygomatic bone, the frontal process of the zygomatic bone and the zygomatic process of the frontal bone.

Foramina

The optic nerve and the ophthalmic artery enter the orbit through the optic canal.

The trochlear, oculomotor, abducens and ophthalmic nerves and the superior ophthalmic vein enter the orbit through the superior orbital fissure.

The inferior ophthalmic vein enters the orbit through the inferior orbital fissure.

Biochemistry	Normal Value
Sodium	135 – 145 mmol/l
Potassium	3.0 – 4.5 mmol/l
Urea	2.5 – 7.5 mmol/l
Glucose	3.5 – 5.0 mmol/l
Creatinine	35 – 135 μmol/l
Alanine Aminotransferase (ALT)	5 – 35 U/l
Gamma-glutamyl Transferase (GGT)	< 65 U/l
Alkaline Phosphatase (ALP)	30 – 135 U/l
Aspartate Aminotransferase (AST)	< 40 U/l
Total Protein	60 – 80 g/l
Albumin	35 – 50 g/l
Globulin	2.4 – 3.5 g/dl
Amylase	< 70 U/l
Total Bilirubin	3 – 17 μmol/l
Calcium	2.1 – 2.5 mmol/l
Chloride	95 – 105 mmol/l
Phosphate	0.8 – 1.4 mmol/l

Haematology	Normal Value
Haemoglobin	11.5 – 16.6 g/dl
White Blood Cells	4.0 – 11.0 x 10⁹/l
Platelets	150 – 450 x 10⁹/l
MCV	80 – 96 fl
MCHC	32 – 36 g/dl
Neutrophils	2.0 – 7.5 x 10⁹/l
Lymphocytes	1.5 – 4.0 x 10⁹/l
Monocytes	0.3 – 1.0 x 10⁹/l
Eosinophils	0.1 – 0.5 x 10⁹/l
Basophils	< 0.2 x 10⁹/l
Reticulocytes	< 2%
Haematocrit	0.35 – 0.49
Red Cell Distribution Width	11 – 15%

Blood Gases	Normal Value
pH	7.35 – 7.45
pO2	11 – 14 kPa
pCO2	4.5 – 6.0 kPa
Base Excess	-2 – +2 mmol/l
Bicarbonate	24 – 30 mmol/l
Lactate	< 2 mmol/l

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Questions Answered: 190

Final Score 35%

Reference Ranges

Questions

Anatomy

Head and Neck

Answer:

Bony Orbit

Anatomy / Head and Neck / Orbit and Eye

Last Updated: 11th April 2019

Orbital Rim

Foramina

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