Endoscopic Treatment of Cranioorbital Fractures

Objective: To devise the technique of endoscopic surgery in cranioorbital trauma.

Materials and Methods: During the period from 01/08/2011 to 01/09/2012 in the N.V. Sklifosovskii Research Institute of Emergency Medical Care, 6 patients with isolated outer table frontal sinus fracture, 2 patients with blow-out fracture of the orbital roof, and 12 patients with sphenoid sinus fractures and cerebrospinal fluid (CSF) leakage were treated by the endoscopic approach. In first group to access depressed fragments, a 7-cm horizontal skin incision was done 1.5 cm behind the hairline in the central plane. Rigid 4-mm, 30-degree endoscope elevators were used to expose the defect in a subperiosteal plane. To repair a frontal sinus fracture, we used thin (0.3 mm) titanium microplates, which were rigidly fixated by percutaneous-placed 5-mm screws. A 3-cm eyebrow incision was used to access the fracture of the orbital roof. Through the frontal sinus by endoscopic control, the fracture fragments were removed and reconstruction of the orbital roof by titanium mesh was performed. Transnasal closure of the sphenoid defect with 4-mm, 0- and 30-degree endoscopes was produced with muscle, mucosa of middle nasal concha, or a combination with DuraSeal.

Results: In all patients with fractures of the anterior wall of the frontal sinus and orbital roof, we obtained good cosmetic and functional outcomes. There were no complications. There was one case of CSF leakage recurrence 2 days after surgery among 11 patients with sphenoid sinus defects. The fistula was closed from the second attempt with DuraSeal and middle nasal conchae fragments and lumbar drainage application.

Conclusions: The endoscopic technique for treatment of skull base and cranioorbital fractures decreases morbidity and prevents complications of traditional approaches such as extensive scarring and alopecia.