Video-Assisted and Ct Navigated Reposition of an Orbital Blow-Out Fracture

Abstract

One possible use of CT navigated surgery in Otorinolaryngology includes traumatology of the facial skeleton. CT navigation enables a surgeon to assess the range and quality of reposition and fixation of a fracture, in our case the fracture of the orbital floor, using a navigated tube. We proceed from pre-operative CT of the paranasal sinuses images to navigation with 1,5-2,0 mm incisions and subsequent registration. Formerly, we used mainly transantral approach at our department, while currently we prefer subciliar approach with the use of absorbable materials (PDS or PMR splint). We use a rigid endoscope for infraorbital nerve decompression and delicate removal of free bone fragments from the maxillary sinus. We applied this procedure in 2 patients. We verified the range of decompression, degree of reposition of the orbital blow-out fracture, and placement of PMR splint and titanium grid using video navigation.

Indications for repositioning of blow-out fractures of the orbital floor based on new objective criteria - tissue protrusion volumometry

“…Two weeks are enough for the orbital hematoma and edema to subside or reduce and to prepare the patient for surgery Kwon et al divided orbital floor fractures into anterior, posterior and anteroposterior 12 . But there is a very large dispersion of functional results, 8.7-67%, especially in the persistence of postoperative diplopia 5,7,[13][14][15][16][17] . Worth noting is the contribution of CT-guided surgery, leading to the complete disappearance of postoperative diplopia.…”

“…The first functional results with CT navigation were not published until 2014 (ref. [5][6] . Beumer, Pham and Schramm [18][19][20] recommend the use of CT navigation in maxillofacial bone fractures to minimize post-traumatic enophthalmos and for improved facial symmetry.…”

“…In our previous works, we focused on anatomical and functional results in operated patients with fractures of the orbital floor in relation to the access routes, types of fixation materials, the use of CT-guided surgery and the proper timing of surgical treatment 5,6 . In the past, the only indication for surgical treatment of these fractures was the clinical finding and its evolution over time.…”

The application of volumometry as an indication criterion in blow-out fractures

“…On the basis of our previous retrospective study, we identified two critical volumes for indicating surgical treatment in blow-out fractures: 500 mm 3 in anterior and posterior fractures and 1400 mm 3 in anteroposterior fractures. We focused on the creation of new quantitative indication criteria for surgical therapy by calculating the volume of proplapsed soft tissues of the orbit and determining the critical values 3,4 .…”