Endoscopic Transnasal Approach for Treatment of the Medial Orbital Blowout Fracture Using Nasal Septum Graft

Carlos R. Ballin; Luiz C. Sava; Carlos A. S. Maeda; Gustavo F. Nogueira; Yasser Jebahi; Henrique W. Sava; Karyn R. J. Koladicz

doi:10.1055/s-0028-1112225

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2009; 25(1): 003-007
DOI: 10.1055/s-0028-1112225

Endoscopic Transnasal Approach for Treatment of the Medial Orbital Blowout Fracture Using Nasal Septum Graft

Carlos R. Ballin¹ , Luiz C. Sava¹ , Carlos A.S. Maeda¹ , Gustavo F. Nogueira¹ , Yasser Jebahi¹ , Henrique W. Sava² , Karyn R.J Koladicz²

¹Ear, Nose, and Throat Department of Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
²Medical Student of Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil

Abstract

ABSTRACT

We present the experience of the Ear, Nose, and Throat Department of Santa Casa de Misericórdia de Curitiba and Hospital Universitário Cajuru PUC-PR in the transnasal endoscopic approach to medial orbital blowout fractures using nasal septum grafts. Seventeen patients have undergone endoscopic repair since June 2005, and septum grafts were used to maintain the orbital contents in position. All 17 patients were treated with this method. Two patients had diplopia on immediate postoperative evaluation. This symptom was corrected with orthoptic exercises in one patient, and the other had a little residual diplopia. Postoperative computed tomography scans showed anatomic reduction in 14 of 17 cases. There were no complications in these surgeries. The transnasal endoscopic approach is a reasonable method for the treatment of medial orbital blowout fractures. Use of septum graft is another surgical alternative for this technique.

KEYWORDS

Orbital blowout - endoscopic - septal graft

Full Text

References

REFERENCES

1 Burm J S, Chung C H, Oh S J. Pure orbital blowout fractures: new concepts and importance of medial orbital fracture. Plast Reconstr Surg. 1999; 103 1839-1849
2 Jones D E, Evans J NG. “Blow-out” fractures of the orbit: an investigation into their anatomical basis. J Laryngol Otol. 1967; 81 1109-1120
3 Lee H M, Han S K, Chae S W, Hwnag S J, Lee S H. Endoscopic endonasal reconstruction for blowout fractures of the medial orbital walls. Plast Reconstr Surg. 2002; 109 872-876
4 Chen C T, Chen Y R, Tung T C, Lai J P, Rohrich R J. Endoscopically assisted reconstruction of orbital medial wall fractures. Plast Reconstr Surg. 1999; 103 714-721
5 Dodick J M, Galin M A, Kwitko M. Medial wall fracture of the orbit. Can J Ophthalmol. 1969; 4 377-378
6 Edwards W C, Ridley R W. Blowout fracture of medial orbital wall. Am J Ophthalmol. 1968; 65 248-249
7 Thering H R, Bogart J N. Blowout fracture of the medial orbital wall with entrapment of the medial rectus muscle. Plast Reconstr Surg. 1979; 63 848-852
8 Leone Jr C R, Lloyd III W C, Rylander G. Surgical repair of medial wall fractures. Am J Ophthalmol. 1984; 97 349-356
9 Lee M J, Kang Y S, Yang Y J, Lee D Y, Chung Y Y, Rohrich R J. Endoscopic transnasal approach for the treatment of medial orbital blow-out fracture: a technique for controlling the fracture wall with a ballonn catheter and Merocel. Plast Reconstr Surg. 2002; 110 417-426
10 Naraghi M, Kashfi A. Endonasal endoscopic treatment of medial orbital wall fractures via rotational repositioning. Am J Otolaryngol. 2002; 23 312-315
11 Matsuo K, Hirose T, Furuta S, Hayashi M, Watanabe T. Semiquantitative correction of post-traumatic enophthalmos with sliced cartilage grafts. Plast Reconstr Surg. 1989; 83 429-437
12 Wiesenbaugh J, Beil M C. Orbital floor repair with nasal septal cartilage. Trans Int Conf Oral Surg. 1973; 4 308-310
13 Stark R B, Frileck S P. Conchal cartilage grafts in augmentation rhinoplasty and orbital floor fracture. Plast Reconstr Surg. 1969; 43 591-596
14 Copeland M, Meisner J. Maxillary antral bone graft for repair of orbital fractures. J Craniofac Surg. 1991; 2 18-21
15 Maves M D, Matt B H. Calvarial bone grafting of facial defects. Otolaryngol Head Neck Surg. 1986; 95 464-470
16 Converse J M, Cole G, Smith B. Late treatment of blow-out fracture of the floor of orbit: a case report. Plast Reconstr Surg. 1961; 28 183-191
17 Dost P. Orbitabodenrekonstruktion mit autologum periosttransplantat. Laryngorhinootologie. 1996; 75 57-58
18 Smith J D, Abramson M. Membranous vs. endochondral bone autografts. Arch Otolaryngol. 1974; 99 203-205
19 Goldman R J, Hessburg P C. Appraisal of surgical correction in 130 cases of orbital floor fractures. Am J Ophthalmol. 1973; 76 152-155
20 Rubin P A, Bilyk J R, Shore J W. Orbital reconstruction using porous polyethylene sheets. Ophthalmology. 1994; 101 1697-1708
21 Polley J W, Ringer S L. The use of Teflon in orbital floor reconstruction following blunt facial trauma: a 20-year experience. Plast Reconstr Surg. 1987; 79 39-43
22 Scapini D A, Mathog R H. Repair of orbital floor fractures with Marlex mesh. Laryngoscope. 1989; 99 697-701
23 Sewall S R, Pernoud F G, Pernoud M J. Late reaction to silicone following reconstruction of an orbital floor fracture. J Oral Maxillofac Surg. 1986; 44 821-825
24 Morrison A D, Sanderson R C, Moos K F. The use of Silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years. J Oral Maxillofac Surg. 1995; 53 412-417
25 Lai A, Gliklich R E, Rubin P A. Repair of orbital blow-out fractures with nasoseptal cartilage. Laryngoscope. 1998; 108 645-650
26 Emery J M, von Noorden G K, Schlernitzauer D A. Orbital floor fractures: long-term follow-up of cases with and without surgical repair. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75 802-812
27 Browning C W. Alloplastic materials in orbital repair. Am J Ophthalmol. 1967; 63 955-962
28 Nicholson D H, Guzak S V. Visual loss complicating repair of orbital floor fractures. Arch Ophthalmol. 1971; 86 369-375

Carlos R BallinM.D.

Adjunct Professor of Ear, Nose, and Throat of Pontifícia Universidade Católica do Paraná (PUCPR)

Curitiba, Brazil

Email: cballin@uol.com.br