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.

Validity and accuracy of subciliary endoscopic-aided repair of orbital floor fractures

“…The present study supports early surgical intervention if the defect is large, as well as if the force-duction test is positive, which would denote deWnite entrapment of the periorbital contents and would not be expected to resolve spontaneously. Endoscopic reduction is a surgical method mainly used as an adjuvant to open surgery in blowout fractures and is rarely used on its own [9], and has been attempted in recent years [14]. Limitations of its use are the potential for injury to the medial canthal ligament and the diYculty in placing a large bone graft.…”

“…Visualizing the posterior aspect of the fracture also is diYcult with this approach [9]. But Strong [14] used the endoscope to repair the orbital fractures via a transmaxillary approach, and he concluded that orbital fractures can be evaluated and repaired endoscopically, and suggested that the endoscopic approach is a safe and eYcacious technique for orbital fracture repair, and oVered improved visualization, anatomic fracture repair and good clinical results.…”

“…Strong [14] stated that the transmaxillary endoscopic approach to orbital Xoor fractures oVers excellent visualization of the entire orbital Xoor, and the fracture can be evaluated and repaired endoscopically without the need for an eyelid incision. He suggested that the use of the endoscopic approach for orbital Xoor fracture repair is a safe and eYcacious technique.…”

“…The use of endoscopy through the subciliary incision to help in proper visualization of the posterior part of the orbital Xoor and conWrm accuracy of repair has not been widely used, and the subciliary incision itself was claimed to be followed by eyelid problems in a relatively high percentage of patients [14], most importantly entropion, although this complication resolved with conservative management [15].…”

Predictability in orbital reconstruction: A human cadaver study. Part I: Endoscopic-assisted orbital reconstruction

“…Because the maxillary sinus provides a confined surgical space, endoscopic management of orbital floor fractures is technically the easiest. Trans-sinusoidal endoscopy reportedly offers excellent visualization and allows confirmation of secure and accurate implant placement (Strong, 2004). Strong (2004) advocated that the indications for endoscopic repair are identical to those for conventional repair.…”