Endoscopic Endonasal Versus Transfacial Approach for Blowout Fractures of the Medial Orbital Wall

Abstract

In the last decades, the introduction of computed tomography has allowed an increase in the number of diagnosed fractures of the medial orbital wall. To repair medial wall fractures, many surgical techniques have been proposed (1), each one with its advantages and disadvantages. In this study, we compared endoscopic endonasal and transcutaneous reduction approaches in terms of surgery time and clinical outcome. Between 2001 and 2005, 81 patients with orbital wall fractures were treated at our department. Among these 81 patients, 24 (29.63%) were affected by a medial orbital fracture. Patients with fracture to both floor and medial walls underwent floor reduction by a transcutaneous subpalpebral approach (n = 9, 11.1%), whereas patients with isolated medial wall fracture underwent medial wall reduction by a transcutaneous subpalpebral approach using alloplastic implants (n = 8, 9.88%) or were treated by endoscopic approach (n = 5, 6.17%). After surgery, oculomotor function improved in all 22 patients. None of the patients had complications. Computed tomography revealed a well-consolidated site of fracture in both endoscopic endonasal and transcutaneous approaches. The average operating time for endoscopic endonasal and transfacial approach was 50 and 45 minutes, respectively. In this paper, the author proposed a results comparison between the endoscopic approach and the transcutaneous one.

Feasibility Study for Transnasal Endoscopic Repair of Orbital Floor Fracture With Alloplastic Implant

“…Based on our experience and previous reports, [8][9][10] repair via wide endoscopic endonasal maxillary antrostomy is best suited for posterior and medial fractures. Based on our experience and previous reports, [8][9][10] repair via wide endoscopic endonasal maxillary antrostomy is best suited for posterior and medial fractures.…”

“…Endoscopic transantral visualization as an adjunct to a traditional periorbital approach is shown to improve rates of diplopia and enophthalmos. 10 Successful repair of medial orbital wall fracture using an alloplastic implant material has been reported. 1 Endoscopic advances have also made a transnasal approach feasible.…”

Orbital medial wall fractures: purely endoscopic endonasal repair with polyethylene implants

“…Other authors have proposed their case series of transnasal management of medial wall fractures with (Copelli and colleagues) or without (Pagnoni and colleagues) the aid of navigation. These authors, however, did not reconstruct the bony wall and relied upon long‐term nasal packing (2–3 weeks) to obtain the desired correction.…”

“…Recently, some small case series shed a new light on the soundness of endoscopic approaches . Most authors rely on the use of Silastic sheets and nasal packing to maintain the orbital content in place, with obvious drawbacks .…”

“…Recently, some small case series shed a new light on the soundness of endoscopic approaches. 4 Most authors rely on the use of Silastic sheets and nasal packing to maintain the orbital content in place, with obvious drawbacks. 2 Use of resorbable panels or autologous materials (bony fragments or septal cartilage) has been proposed in case reports only.…”