33 - Endoscopic Orbital Fracture Repair

Abstract

Among the seven bones composing the orbit, the maxillary bone and the ethmoid bone represent the thinnest boundaries. Therefore blunt trauma to the orbit most often results in inferior and/or medial wall fractures rather than lateral wall and orbital roof injuries. More specifically, the lamina papyracea of the ethmoid bone, aptly named because of its extreme frailty, composes most of the medial orbital wall, which makes medial wall fractures very common. Medial and inferior orbital wall fractures do not necessarily have absolute surgical indications (small, isolated blow-out medial wall fractures generally might not require treatment, although late enophthalmos can become an aesthetic concern for such patients). However, complications are very likely to occur with fractures exceeding 1cm2 or 50% of the wall. Furthermore, extrinsic orbital muscle impinging in the fracture margins, thereby inducing ophthalmoplegia and subsequent diplopia, represents another general indication for medial and inferior orbital wall fractures repair. This chapter focuses on the treatment of medial orbital wall fractures, with special emphasis on transnasal endoscopic approaches, which allow for excellent functional and esthetic results while completely avoiding problems related to external approaches. The last section of the chapter provides useful information on managing complex fractures with the aid of endoscopy and on using endoscopy as a tool to address the management of complex orbital fractures.