Endoscopic Repair of Orbital Blow-Out Fractures

ABSTRACT

Orbital floor blow-out fractures (OBFs) result from trauma to the globe and periorbita. These fractures occur in repeatable patterns that can be endoscopically classified as either medial or lateral to the infraorbital nerve (V₂). Medial fractures are the most common and can be separated into “trap door” and “blow-out” fractures. Fractures that extend lateral to V₂ are generally higher velocity injuries that result in comminution of the entire orbital floor. The key to successful surgical repair of these injuries is adequate exposure, visualization of the posterior bone shelf, and anatomic repair of the entire defect. Visualization of the posterior shelf can be challenging through traditional transconjunctival and subciliary approaches. These approaches also have known risks of postoperative eyelid malposition. The transmaxillary endoscopic approach to OBFs offers excellent visualization of the entire orbital floor. Fracture types can be evaluated and repaired endoscopically without the need for an eyelid incision. Although this is a new and evolving technique, early experience suggests that the endoscopic approach is a safe, efficacious technique for OBF repair. It offers improved visualization, anatomic fracture repair, no risk of postoperative eyelid complications, and good clinical results.

KEYWORDS

Endoscopic surgery - orbital blow-out fracture

REFERENCES

• 1 Jones D EP, Evans J NG. “Blow-out” fractures of the orbit: an investigation into their anatomical basis.  J Laryngol Otol. 1967;  81 1109-1120
• 2 Zingg M, Chowdhury K, Ladrach K et al.. Treatment of 813 zygoma-lateral orbital complex fractures.  Arch Otolaryngol Head Neck Surg. 1991;  117 611-620
• 3 Appling W D, Patrinely J R, Salzer T A. Transconjunctival approach vs. subciliary skin-muscle flap approach for orbital fracture repair.  Arch Otolaryngol Head Neck Surg. 1993;  119 1000-1007
• 4 Mullins J B, Holds J B, Branham G H et al.. Complications of the transconjunctival approach: a review of 400 cases.  Arch Otolaryngol Head Neck Surg. 1997;  123 385-388
• 5 Walter W L. Early surgical repair of blow-out fracture of the orbital floor by using the transantral approach.  South Med J. 1972;  65 1229-1243
• 6 Ikeda K, Suzuki H, Oshima T et al.. Endoscopic endonasal repair of orbital floor fracture.  Arch Otolaryngol Head Neck Surg. 1999;  125 59-63
• 7 Chen C T, Chen Y R. Endoscopically assisted repair of orbital floor fractures.  Plast Reconstr Surg. 2001;  108 2011-2018
• 8 Saunders C J, Whetzel T P, Stokes R B et al.. Transantral endoscopic orbital floor exploration: a cadaver and clinical study.  Plast Reconstr Surg. 1997;  100 575-581
• 9 Woog J J, Hartstein M E, Gliklich R. Paranasal sinus endoscopy and orbital fracture repair.  Arch Ophthalmol. 1998;  116 688-691
• 10 Gray L N, Kalimuthu R, Jayaram B et al.. A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach.  Br J Plast Surg. 1985;  38 113-115
• 11 Chen C T, Chen Y R, Tung T-C et al.. Endoscopically assisted reconstruction of orbital medial wall fractures.  Plast Reconstr Surg. 1999;  103 714-720
• 12 Lee M J, Kang Y S, Yang J Y et al.. Endoscopic transnasal approach for the treatment of medial orbital blow-out fracture: a technique for controlling the fractured wall with a balloon catheter and Merocel.  Plast Reconstr Surg. 2002;  110 417-426
• 13 Yamaguchi N, Arai S, Mitani H, Uchida Y. Endoscopic endonasal technique of the blow-out fracture of the medial orbital wall.  Oper Techn Otolaryngol Head Neck Surg. 1991;  2 269-274
• 14 Michel O. Medial orbital wall fractures: results of minimally invasive endoscopically controlled endonasal surgical technique.  Laryngorhinootologie. 1993;  72 450-454
• 15 Rhee J S, Lynch J, Loehrl T A. Intranasal endoscopy-assisted repair of medial orbital wall fractures.  Arch Facial Plast Surg. 2000;  2 269-273
• 16 Forrest C R. Application of endoscopic-assisted minimal-access techniques in orbitozygomatic complex orbital floor and frontal sinus fractures.  J Craniomaxillofac Trauma. 1999;  5 7-12
• 17 Lee C H, Lee C, Trabulsy P P et al.. A cadaveric and clinical evaluation of endoscopically assisted zygomatic fracture repair.  Plast Reconstr Surg. 1998;  101 333-347
• 18 Lee C, Mankani M, Kellman B, Forrest C R. Minimally invasive approaches to mandibular fractures.  Facial Plast Surg Clin North Am. 2001;  9 475-482
• 19 Parrish R, Bernadino V. Iridectomy in the surgical management of eight-ball hyphema.  Arch Ophthalmol. 1982;  100 435-437