Nasal endoscopy-assisted reconstruction of orbital floor blowout fractures using temporal fascia grafting

PURPOSE: To present the experience and outcomes of an endoscopy-assisted reconstruction of isolated orbital floor blowout fractures using temporalis fascia grafting.

MATERIALS AND METHODS: A retrospective chart review of 32 patients who underwent repair of orbital floor fractures using temporalis fascia grafting from January 1, 2004, through December 1, 2009, was conducted. All procedures were performed through an upper buccal sulcus incision and a transmaxillary endoscopic approach to the orbital floor. The area of displaced bone fragments was limited to 2 cm(2) in all patients in this study. The parameters evaluated before and after surgery included visual acuity, extraocular motility and diplopia, and exophthalmometry. All patients underwent computed tomography before and 6 months after surgery.

RESULTS: None of the 32 patients had a postoperative clinical infection or obvious inflammation. Visual acuity was better than or equal to 20/100 in 43% of patients before surgery compared with 76% of patients after surgery. All patients had diplopia before surgery; only 3 had diplopia 6 months after surgery. Enophthalmos was observed in all patients before surgery, and 4 patients still displayed enophthalmos at 6 months after surgery. No sagging of the reconstructed orbital floor was found on computed tomograms 6 months after surgery.

CONCLUSIONS: This retrospective study is the first to show that the temporalis fascia is a reliable implant for the repair of orbital floor defects smaller than or equal to 2 cm(2).