Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

Norihiko Narita,Shigeharu Fujieda,Tetsuji Takabayashi,Yoshimasa Imoto,Masayuki Okamoto,Kazuhiro Ogi,Yukihiro Kimura,Yukinori Kato,Yumi Ito

doi:10.3390/ohbm2030007

Abstract

Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.

Highlights

Orbital floor fracture of both types can cause diplopia, it is more severe in cases of trapdoor fracture (TF)
Regarding indication of reconstruction, prolonged oculocardiac reflex, white-eyed blowout fracture (BOF), enophthalmos, diplopia in eye movement, breakdown over 50% of the orbital floor, and entrapment of orbital soft tissues were described in an earlier report [3]
Operations for BOF and TF with the single transorbital approach are frequently performed by maxillofacial surgeons or ophthalmologists

Summary

Introduction

BOF caused by the breakdown of the orbital floor to various degrees can engender dislocation of orbital soft tissues such as fat tissue and extraocular muscle. Orbital floor fracture of both types can cause diplopia, it is more severe in cases of TF. Constriction of the inferior rectus muscle without early surgical reconstruction leads to permanent diplopia. Various surgical approaches, including transantral, transorbital, and endonasal endoscopic approaches, or a combination of them, have been performed for orbital floor reconstruction. We have used the combined surgical procedure with a subciliary transorbital and transantral approach using an endoscope for BOF and TF reconstruction since August 2009. The combined approach can be followed more safely and more effectively than single approaches for both BOF and TF reconstruction. This report, which retrospectively assessed clinical outcomes of the combined approach, describes the combined approach for TF reconstruction in children

Methods

Results

Discussion

Conclusion