Transnasal Endoscopic Approach for the Treatment of Medial Orbital Wall Fractures.

Luisa Valente,Andrea Ciorba,Anna Bonsembiante,Stefano Pelucchi,Manlio Galiè

doi:10.4103/ams.ams_173_19

Abstract

The aim of this study is to report a case series of blowout fractures of the medial orbital wall that were treated endoscopically. Isolated fractures of the medial orbital wall are uncommon and can be asymptomatic. Various surgical methods for repairing medial orbital wall fractures have been described. The standard approach for the treatment of medial orbital wall fractures is the transcutaneous approach or the transconjunctival with retrocaruncular approach. In the last years, the attention on the use of minimally invasive techniques such as transnasal endoscopic approach is growing. This was a retrospective study of six cases completely managed endoscopically. In the presented case series, the endoscopic endonasal approach represented a safe and effective procedure for the reduction of medial wall orbital fractures.

Highlights

Since 1921, the standard surgical approach for the treatment of medial wall orbital fractures has been the transcutaneous approach, first described by Lynch.[2]
The aim of this study is to describe the surgical outcome of blowout fractures of the medial orbital wall treated endoscopically at our university settings
The incision is made over the medial canthal area followed by dissection of both periosteum and medial canthal tendon, and the herniated orbital tissue can be replaced into the orbital cavity

Summary

Introduction

Since 1921, the standard surgical approach for the treatment of medial wall orbital fractures has been the transcutaneous approach (medial canthal incision or Lynch incision approach[1]), first described by Lynch.[2] Later, different approaches have been reported, such as transcaruncular approach, transconjunctival incision, and inferior or superior eyelid incision.[3,4] Major drawbacks of these techniques are the esthetic outcome and the limited exposure of the fracture site. The first endoscopic endonasal surgical approach for the treatment of medial wall orbital fractures was described in 1991 by Yamaguchi.[3] Since its introduction, the endoscope has become an indispensable instrument for endonasal surgery.[4] Nowadays, this surgical treatment can be performed under local or general anesthesia, depending on fracture and patient status.[5]. The aim of this study is to describe the surgical outcome of blowout fractures of the medial orbital wall treated endoscopically at our university settings

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Discussion

Yes No Yes No Yes No

Case Side of fracture

Findings

Stabilization and medication