Endoscopic endonasal repair of blowout fractures of the orbital floor

Abstract

Objectives: This study is to show the usefulness of the endoscopic endonasal approach in the surgical treatment of isolated blowout fractures of the orbital floor. Methods: Between 1997 and 2003 we operated on 65 patients complaining of diplopia due to isolated blowout fractures of the orbital floor, including 4 patients accompanied with enophthalmos. In 62 of the 65, only the endonasal approach with endoscope was used, while in the remaining 3 patients, we used the combined endonasal and transantral approach. To do the endonasal repair surgery smoothly under the endoscope, via the middle nasal meatus, septoplasty was supplemented in 13 patients and submucous conchotomy in 57. The bone fragments trapping the orbital content herniated into the maxillary sinus were carefully removed so as to keep the periorbita intact. Tampon gauzes or a balloon catheter for temporal fixation was placed in the maxillary sinus through the middle nasal meatus to support the orbital floor for 2 to 7 days. No permanent supporting material was used. Immediately following the repair and the fixation the eye traction test was respectively performed to confirm that the eyeball was freely moving. Results: Postoperatively diplopia disappeared in 50 of the 57 patients using only the endonasal approach, (87.7%) and enophthalmos improved 3 of 4 followed over 6 months. Conclusions: From this high success rate with respect especially to diplopia we conclude that the endoscopic endonasal approach is alternative to extranasal methods in view of cosmetics and the improvement of eye movement.