Combination of transorbital and endoscopic transnasal approaches to repair orbital medial wall and floor fractures

Wodong Shi, Renbing Jia, Zhengkang Li, Dongmei He, Xianqun Fan
Journal of Craniofacial Surgery 2012, 23 (1): 71-4

PURPOSE: This study aimed to illustrate the effectiveness of the combination of the transorbital and the endoscopic transnasal approach in the repair of medial wall and floor orbital fractures in Chinese patients.

METHODS: A retrospective study was carried out on 25 Chinese patients (18 men and 7 women) with orbital medial wall and floor fractures. All patients had enophthalmos more than 2 mm, 23 had diplopia, and 11 had eye movement restriction. Bone defect involving both medial and inferior walls was found with computed tomographic scans in all patients. In all 25 patients, surgery was done by 1 surgeon group using the transorbital and the endoscope-assisted transnasal approach. The endoscope was used to give a clear view of the posterior edge of the fracture. Titanium meshes were used to repair fractures of the orbital floor and the medial wall. Porous polyethylene sheet implants were used to recover the orbital volume. All patients were followed up 12 months after surgery.

RESULTS: Enophthalmos was corrected in all 25 patients immediately, diplopia disappeared or improved in 21 of 23 cases, and eye movement restriction was released or improved in all 11 patients. No significant complications occurred. The titanium mesh was completely covered by nasal mucosa at 1 month after surgery by an endoscopic check.

CONCLUSIONS: The endoscope-assisted transnasal approach allows for excellent visualization of the extent of the fracture, particularly in areas that are difficult to visualize by conventional methods. The combination of the transorbital and the endoscope-assisted transnasal approach is a good way to reconstruct a large orbital wall fracture involving the floor and the medial wall.

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