Transantral Endoscopic Orbital Floor Exploration: A Cadaver and Clinical Study

Saunders, Christopher J.; Whetzel, Thomas P.; Stokes, Russell B.; Wong, Granger B.; Stevenson, Thomas R.

doi:10.1097/00006534-199709000-00003

Cited by 73 publications

(38 citation statements)

References 23 publications

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“…large orbital floor fractures (³ 2 cm 2 , ³ 50 % of the orbital floor) have a significant risk of developing enophthalmos and require surgical treatment, 2. small or linear fractures are best managed without surgery [5]. Early surgical intervention has also been advocated [9].…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic transmaxillary reduction for blowout fractures of the orbital floor was reported in 1997 by Saunders et al [5]. The endoscopic transmaxillary approach yields a wide operative field from various directions with enhanced illumination and can reduce the fracture of orbital floor with entrapped orbital tissue from the sinus into the orbit.…”

Section: Discussionmentioning

confidence: 99%

“…The endoscopic transmaxillary approach yields a wide operative field from various directions with enhanced illumination and can reduce the fracture of orbital floor with entrapped orbital tissue from the sinus into the orbit. This method allows easier manipulation than with transorbital repair, especially in the posterior portion of the orbital floor [5,12].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Transmaxillary Reduction and Balloon Technique for Blowout Fractures of the Orbital Floor

Miki¹,

Wada²,

Haraoka³

et al. 2004

Minim Invasive Neurosurg

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The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Transmaxillary Reduction and Balloon Technique for Blowout Fractures of the Orbital Floor

Miki¹,

Wada²,

Haraoka³

et al. 2004

Minim Invasive Neurosurg

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“…Extraocular muscle restriction or a considerable dislocation of the globe causes diplopia. To asses the extent of a fracture and herniation of the soft orbital tissues into the maxillary antrum (12), either a CT examination of the orbits and the paranasal sinuses in the coronal plane (11) or an endoscopy of the antral cavity is used. Following these examinations, a decision is made whether surgical intervention and reduction should be performed.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of an Orbital Floor Fracture in a 4-Year-Old Child

Chrobok

Pellant

Novák

et al. 2008

Acta Med. (Hradec Kralove, Czech Repub.)

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The most frequent orbital wall fractures involve the orbital floor. Such fractures can be divided into transmarginal and retromarginal (blowout) fractures. Two theories of retromarginal fracture aetiology have been described: the hydraulic theory and the bone conduction mechanism.The former refers to a direct force to the globe and its compression (blowout), which increases intraorbital pressure and leads to a fracture of the weakest point of the orbital bone (the orbital floor or the medial orbital wall). The latter suggests a force to the lower orbital rim, which transfers pressure to the orbital floor and results in its fracture (9).A conservative or a surgical therapeutic approach should be selected according to the extent and localization of the injury and according to the difficulties exhibited by the patients. In addition, retromarginal fractures of the orbital floor in children are unique due to the pathology involved in the orbital bone injury and due to a distinctive surgical approach.The report presents a fracture of the orbital floor in a child. Furthermore, therapeutical options in retromarginal fractures of the orbital floor are discussed. Case ReportA 4-year-old girl was running in a garden and hit her face against an agricultural machine. Subsequently, she started to bleed from her nose, and a haematoma of her left lower eyelid and her left cheek developed. She did not have any period of unconsciousness. A CT examination of the orbits and the paranasal sinuses in the coronal plane revealed a retromarginal fracture of the orbital floor with large soft tissue herniation into the maxillary antrum ( Fig. 1) with no ocular muscle restriction. A consulting ophthalmologist did not find any visual acuity impairment. Furthermore, movements of the eyeballs were not restricted, and the child did not report diplopia. Oedema subsided on the 6th day after the injury, and surgery was performed. The indication for surgery was a large soft tissue herniation in the maxillary sinus. Bone fragments of the orbital floor and a tear of the perforated orbital periosteum were found after performing a transconjuctival incision combined with a lateral canthotomy. After lifting the soft orbital tissues and the orbital periosteum from the maxillary antrum, a partly absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum to provide support. A forced duction test prior to and after the reduction proved an absence of extraocular muscle restriction. Next, the incision was sutured. After the surgery the child made an uneventful recovery, her visual acuity was not impaired, her eyeball movements were not restricted, and diplopia was not present. A follow-up MRI examination of the orbits and the paranasal sinuses one month after the surgery demonstrated the collagenous mesh and the orbital soft tissues in a good position without any signs of dislocation into the maxillary antrum (Fig. 2). DiscussionThe region medial to the infraorbital neurovascular bundle, approximately 10 mm posterior to...

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“…3 Although a variety of approaches to orbital floor fractures have been proposed, satisfactory postoperative results have not been obtained in all cases. 7,11,18,19,23,24,27 The key to successful surgical repair of these injuries is adequate exposure, visualization of the posterior bone shelf, and anatomical reconstruction of the entire defect. The traditional approach exposes the orbital floor, but it is difficult to see the posterior edge of the fracture and the condition of the herniated tissue before and after reduction of the orbital contents.…”

mentioning

confidence: 99%