Endoscope-Assisted Repair of Medial Orbital Wall Fractures Using a Retrocaruncular Approach

Abstract

s t p i c t w b a outine computed tomography (CT) scan of facial rauma now shows more medial orbital wall fractures han noted previously. Also, the incidence of this racture has increased in recent years owing to a rise n the incidence of high-energy impact orbital trauma nd in sport activities. The indications and timing for his fracture repair remain controversial. In our center, reatment is performed in cases of fractures that exceed cm in size or small fracture sizes ( 1 cm) with linical problems. Operative treatment becomes unecessary unless a displaced medial wall fracture shows linical diplopia, enophthalmos, any signs of herniation f orbital contents into the ethmoid sinus, or true ncarceration of medial rectus muscle, resulting in the imitation of ocular motility; or massive orital emphysema with secondary ophthalmic probems, such as a rapidly progressive proptosis and isual loss. Numerous surgical approaches have been used in xploratory surgery of medial orbital wall fractures; it emains a challenging area for surgeons due to techical difficulties and postoperative scars. Compared ith the cutaneous approaches, the transconjunctival nd retrocaruncular approaches not only provide an ppropriate exposure but avoid postoperative scars nd webbing. Evolving these surgical techniques ith lesser side effects, and an increasing demand of atients toward cosmetic rehabilitation, have led to the se of endoscope for disfiguring injuries. It is clear that he role of endoscope in this fracture repair recently has een shown with the advent of improved technology of