Objective criteria for choosing an operative approach in case of orbital floor fractures

Abstract

The aim of the study Id to determinate of objective criteria for the choice of operative access in fractures of the lower wall of the eye socket. As an objective assessment of surgical approaches, the magnitude of the surgical action and the wound depths are used. Computer modeling of transorbital and transantral surgical approach is performed on 390 eye sockets based on computed tomograms with a virtual representation of the eye structure of fractures of the anterior, middle and posterior parts. In case of orbital floor fractures in the anterior part, both transorbital and transantral approaches have satisfactory indicators of operational impact. For fractures in the posterior part, the transorbital approach in the overwhelming majority of cases shows unsatisfactory parameters of objective criteria. For fractures in the middle part, the transantral approach shows the better parameters. The parameters of transorbital access in this case can be considered satisfactory, however, in orbital floor fractures of the middle part, in order to place the implant on undamaged areas of the bone, access to the posterior part of the orbital floor is also required, which leads to unsatisfactory indicators of transorbital access in this situation. For fractures in the anterior orbital floor sections, both transorbital and transantral approaches can be used, and for fractures in the middle and posterior parts, the transantral surgical approach is preferable. In case of accompanying trauma of the medial orbital wall and an anterior part of the orbital floor, transorbital access is preferable, and in the case of the same accompanying injury, but with a fracture of the posterior part of the orbital floor, a combined approach from the orbit and maxillary sinus can be used.