Application of Endoscope in Orbital Fractures

ABSTRACT

Surgical treatment of orbital fractures presents one of the most challenging procedures following facial injury. The traditional incisions used for repair of orbital defects, despite proper and meticulous execution, still leave permanent surgical stigmata such as scalp alopecia, facial nerve palsy, prominent scarring, and eyelid retraction. Endoscopic techniques have been widely adopted for esthetic plastic surgery to allow smaller incisions and a shorter convalescence period. To reduce potential unfavorable outcomes and avoid incisional sequelae, endoscopic techniques have been developed and applied for orbital fractures through either medial transconjunctival or transantral approaches. In general, the endoscopic assisted techniques provide magnified vision, enhanced illumination of the surgical field, simultaneous visualization of the fracture site by multiple members of the surgical team, precise determination of the fractures size, location and presence of entrapped orbital contents, complete reduction of herniated soft tissue, and coverage of the bone defect. These procedures can be performed safely with minimal morbidity and excellent cosmetic results without an external scar. However, not all cases are suitable for an endoscopic approach, and the surgeon must be experienced in the full range of surgical options and thoroughly understand the anatomy of the orbit if optimal results are to be achieved.

KEYWORDS

Endoscope - orbital fracture - antrostomy - micromesh - Medpor

REFERENCES

• 1 Dodick J M, Galin M A, Kwitko M. Medial wall fracture of the orbit.  Can J Ophthalmol . 1969;  4 377-378
• 2 Fueger G F, Milauskas A T, Britton W. The roentgenologic evaluation of orbital blow-out injuries.  Am J Roentgenol Radium Ther Nucl Med . 1966;  97 614-617
• 3 Antonyshyn O, Gruss J S, Kassel E E. Blow in fractures of the orbit.  Plast Reconstr Surg . 1989;  84 10-20
• 4 Dodick J M, Galin M A, Littleton J T, Sod L M. Conconmitant medial wall fracture and blow out fracture of the orbit.  Arch Ophthalmol . 1971;  85 273-276
• 5 Gould H R, Titus C O. Internal orbital fractures: the value of laminography in diagnosis.  Am J Roentgenol Radium Ther Nucl Med . 1966;  97 618-623
• 6 Gear A JL, Lokeh A, Aldridge J H, Migliori M R, Benjamin C I, Schubert W. Safety of titanium mesh for orbital reconstruction.  Ann Plast Surg . 2002;  48 1-9
• 7 Kraus M, Gatot A, Fliss D M. Repair of traumatic inferior orbital wall defects with nasoseptal cartilage.  J Oral Maxillofac Surg . 2001;  59 1397-1400
• 8 Wilkins R B, Havins W E. Current treatment of blow-out fractures.  Ophthamology . 1982;  89 464-466
• 9 Manson P N, Iliff N. Management of blow-out fractures of the orbital floor: II. Early repair of selected injuries.  Surv Ophthalmol . 1991;  35 280-298
• 10 Isse N G. Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports.  Aesthet Plast Surg . 1994;  18 21-29
• 11 Vasconez L O, Core G B, Gamboa-Bobadilla M, Guzman G, Askren C, Yamamoto Y. Endoscopic techniques in coronal brow lifting.  Plast Reconstr Surg . 1994;  94 788-793
• 12 Ramirez O M. Endoscopic full facelift.  Aesthet Plast Surg . 1994;  18 363-371
• 13 Al-Qurainy A, Stassen L FA, Dutton G N, Moos K F, EI-Attar A. The characteristics of midfacial fractures and the association with ocular injury: a prospective study.  Br J Oral Maxillofac Surg . 1991;  29 291-301
• 14 Finkle D R, Ringler S L, Luttenton C R, Beernink J H, Peterson N T, Dean R E. Comparison of the diagnostic methods used in maxillofacial trauma.  Plast Reconstr Surg . 1985;  75 32-38
• 15 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;  103 714-720
• 16 Chen C T, Chen Y R. Endoscopically assisted repair of orbital floor fractures.  Plast Reconstr Surg . 2001;  108 2011-2018
• 17 Saunders C J, Whetzel T P, Stokes R B, Wong G B, Stevenson T R. Transantral endoscopic orbital floor exploration: a cadaver and clinical study.  Plast Reconstr Surg . 1997;  100 575-581
• 18 Forrest C R. Application of endoscope-assisted minimal-access techniques in orbitozygomatic complex, orbital floor, and frontal sinus fractures.  J Cranio-Maxillofac Trauma . 1999;  5 7-12
• 19 Grant M P, Iliff N T, Manson P N. Strategies for the treatment of enophthalmos.  Clin Plast Surg . 1997;  24 539-550