PDF herunterladen
Minim Invasive Neurosurg 2004; 47(6): 359-364
DOI: 10.1055/s-2004-830133
Original Article
© Georg Thieme Verlag Stuttgart · New York

Endoscopic Transmaxillary Reduction and Balloon Technique for Blowout Fractures of the Orbital Floor

T.  Miki1 , J.  Wada1 , J.  Haraoka1 , I.  Inaba2
  • 1Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
  • 2Department of Neurosurgery, Shinkawabashi Hospital, Kawasaki City, Japan
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
26. Januar 2005 (online)

    Lizenzen und Reprints

Abstract

The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

Key words

Endoscope - blowout fracture - transmaxillary reduction - maxillary balloon technique

References

  • 1 Converse J M, Smith B. Enophthalmos and diplopia in fracture of the orbital floor.  Br J Plast Surg. 1957;  9 265-274
    PubMedSuche in Google Scholar
  • 2 Johnson M R. Depressed fracture of the orbital rim.  Surg Clin N Am. 1944;  24 340-347
    PubMedSuche in Google Scholar
  • 3 Miki T, Haraoka J, Inaba I, Utsumi T. Maxillary antral balloon technique for blowout fracture.  Neurotraumatology. 2001;  24 57-62
    PubMedSuche in Google Scholar
  • 4 Puttermann A M, Stevens T, Urist M J. Nonsurgical management of blowout fracture of the orbital floor.  Am J Ophthalmol. 1974;  77 232-239
    PubMedSuche in Google Scholar
  • 5 Saunders C J, Whetzel T P, Stokes R G, Wong G B, Stevenson T R. Transantral endoscopic orbital floor exploration: A cadaver and clinical study.  Plast Reconstr Surg. 1997;  100 575-581
    PubMedSuche in Google Scholar
  • 6 Smith B, Regan W F. Blowout fracture of the orbit.  Am J Ophthalmol. 1957;  44 733-739
    CrossrefPubMedSuche in Google Scholar
  • 7 Sugamata A, Watanabe K, Nomoto T. Clinical evaluation of new operative indication for orbital blowout fracture.  J Soc Cranio-maxillo-facial Surg. 2000;  16 54-61
    PubMedSuche in Google Scholar
  • 8 Sugamata A, Makino K. Clinical study of blowout fracture.  J Jpn P R S. 1992;  12 307-319
    PubMedSuche in Google Scholar
  • 9 Converse J M, Smith B, Obear M E, Wood-Smith D. Orbital blowout fracture: a ten-year survey.  Plast Reconstr Surg. 1967;  39 20-35
    CrossrefPubMedSuche in Google Scholar
  • 10 Caldwell G W. Disease of the accessory sinuses of the nose, and an improved method of treatment for suppuration of the maxillary sinus.  NY Med J. 1893;  58 526-528
    PubMedSuche in Google Scholar
  • 11 Luc H. Nouvelle method operation pour la cure radicale et rapide de l'empyeme choronique du sinus maxillaire.  Bull Med Soc Fr. 1897;  457-458
    PubMedSuche in Google Scholar
  • 12 Otori N, Haruna S, Moriyama H. Endoscopic endonasal or transmaxillary repair of orbital floor fracture: A study of 88 patients treated in our department.  Acta Otolaryngol. 2003;  123 718-723
    PubMedSuche in Google Scholar
  • 13 Egbert J E, May K, Kersten R C, Kulwin D R. Pediatric orbital floor fracture. Direct extraocular muscle involvement.  Ophthalmology. 2000;  107 1875-1879
    CrossrefPubMedSuche in Google Scholar
  • 14 Ogawa K, Kohzu N, Sakatsume M, Ohotsuki K, Sato S, Imaizumi H. Antral balloon technique for treatment of the malar bone and blowout fracture.  J Oto-Laryngol Jpn. 1978;  81 487-499
    PubMedSuche in Google Scholar
  • 15 Bahr W, Bagambisa F B, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: A retrospective study.  Plast Reconstr Surg. 1992;  90 585-591
    PubMedSuche in Google Scholar
  • 16 Lorenz H P, Longaker M T, Kawamoto Jr H K. Primary and secondary orbit surgery: The transconjunctival approach.  Plast Reconstr Surg. 1999;  103 1124-1128
    CrossrefPubMedSuche in Google Scholar
  • 17 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
    Suche in Google Scholar
  • 18 Chen C T, Chen Y R. Endoscopic assisted repair of orbital floor fractures.  Plast Reconstr Surg. 2001;  108 2011-2019
    PubMedSuche in Google Scholar

Tamotsu Miki,M. D. 

Department of Neurosurgery · Tokyo Medical University

6-7-1 Nishishinjuku, Shinjuku-ku

Tokyo 160-0023

Japan

Telefon: +81-3-3342-6111

Fax: +81-3-3340-4285 ·

eMail: mikit@qa2.so-net.ne.jp