Subscribe to RSS
DOI: 10.1055/s-0028-1112226
Endoscopic Management of Orbital Floor Fractures
Publication History
Publication Date:
10 February 2009 (online)
![](https://www.thieme-connect.de/media/fps/200901/lookinside/thumbnails/10.1055-s-0028-1112226-1.jpg)
ABSTRACT
The management of orbital floor fractures involves several issues. Different surgeons have diverse opinions about who needs surgery and how best to do it. This is especially so with regard to use of transantral diagnostic and therapeutic endoscopic surgery over traditional lower eyelid approaches. Transantral endoscopy provides precise and complete information about the orbital floor fracture and makes possible the repair of these fractures under unobstructed vision at all times, minimizing the risk of implant misplacement and, hence, enophthalmos. Contrary to popular belief, this technique is versatile and is applicable for most cases of primary repair of orbital floor fractures of variable sizes of defect, regardless of whether they are blowout or trap-door fractures or whether they are associated with other fractures. The great strength of this procedure is that improved visualization is accomplished while obviating the need for lower eyelid incisions and their associated risk of complications. This technique is safe in trained hands, giving predictably good results in suitable patients.
KEYWORDS
Endoscopic surgery - orbital floor fracture - blowout fracture - orbital floor implant - enophthalmos
REFERENCES
- 1 Vasconez L O, Core G B, Oslin B. Endoscopy in plastic surgery. An overview. Clin Plast Surg. 1995; 22 585-589
- 2 Walter W L. Early surgical repair of blowout fracture of the orbital floor by using the transantral approach. South Med J. 1972; 65 1229-1243
- 3 Mohammad J A, Warnke P H, Shenaq S M. Endoscopic exploration of the orbital floor: a technique for transantral grafting of floor blowout fractures. J Craniomaxillofac Trauma. 1998; 4 16-19
- 4 Chen C T, Chen Y R. Endoscopically assisted repair of orbital floor fractures. Plast Reconstr Surg. 2001; 108 2011-2018
- 5 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
- 6 Banerjee A, Moore C C, Tse R, Matic D. Rounding of the inferior rectus muscle as an indication of orbital floor fracture with periorbital disruption. J Otolaryngol. 2007; 36 175-180
- 7 Levine L M, Sires B S, Gentry L R, Dortzbach R K. Rounding of the inferior rectus muscle: a helpful radiologic finding in the management of orbital floor fractures. Ophthal Plast Reconstr Surg. 1998; 14 141-143
- 8 Burnstine M A. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology. 2002; 109 1207-1210
- 9 Hawes M J, Dortzbach R K. Surgery on orbital floor fractures. Influence of time of repair and fracture size. Ophthalmology. 1983; 90 1066-1070
- 10 Burm J S, Chung C H, Oh S J. Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. Plast Reconstr Surg. 1999; 103 1839-1849
- 11 Gray L N, Kalimuthu R, Jayaram B, Lewis N, Sohaey M. A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach. Br J Plast Surg. 1985; 38 113-115
- 12 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
- 13 Kushner G M. Surgical approaches to the infraorbital rim and orbital floor: the case for the transconjunctival approach. J Oral Maxillofac Surg. 2006; 64 108-110
- 14 Mullins J B, Holds J B, Branham G H, Thomas J R. Complications of the transconjunctival approach. A review of 400 cases. Arch Otolaryngol Head Neck Surg. 1997; 123 385-388
- 15 Forrest C R. Application of endoscope-assisted minimal-access techniques in orbitozygomatic complex, orbital floor, and frontal sinus fractures. J Craniomaxillofac Trauma. 1999; 5 7-12
- 16 Farwell D G, Sires B S, Kriet J D, Stanley Jr R B. Endoscopic repair of orbital blowout fractures: use or misuse of a new approach?. Arch Facial Plast Surg. 2007; 9 427-433
- 17 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
Chien-Tzung ChenM.D.
Associate Professor, Chief, Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery
Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 5, Fu-Shing Street, Kweishan 333, Taoyuan, Taiwan
Email: ctchenap@adm.cgmh.org.tw