In Reply.—Dr. Putterman objects to our suggestion that all fractures of the floor of the orbit with clinical symptoms and demonstrable x-ray evidence should be explored. He agrees with the need for early treatment of fractures of the zygomati-comaxillary complex, which involves the orbital floor (impure blow-out) but insists that these should be separated from fractures of the floor alone (pure blow-out). In fact, we carefully separated these two major classifications and suggested the use of coexisting and isolated groupings to emphasize this separation.
Limiting the discussion to the isolated, pure blow-out fracture, Putterman and his associates reject the entrapment of the inferior rectus muscle or penetration of the orbital fat through the damaged floor, or both as a cause of diplopia and enophthalmos. This pathogenesis has been documented in the experimental laboratory and repeatedly at surgery by direct observations and forced traction tests since the early reports of
RANKOW RM, MIGNOGNA FV. Orbital Floor Fractures-Reply. Arch Otolaryngol. 1975;101(11):707. doi:10.1001/archotol.1975.00780400064020
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