Orbital Wall Fracture Research Articles

Pressure Onto the Orbital Walls and Orbital Morphology in Orbital Floor or Medial Wall Fracture: A 3-Dimensional Printer Study.

The purposes of this study were to compare the pressure onto the orbital floor and medial orbital wall between 3-dimensional printer skull models with unilateral orbital floor and medial orbital wall fractures and to compare the morphology of the orbital floor and medial orbital wall between patients with unilateral orbital floor and medial orbital wall fractures. The skull models were created based on computed tomographic (CT) data obtained from every 10 patients with unilateral orbital floor and medial orbital wall fractures. The orbital spaces of these models were filled with silicone, the silicone surface was pushed down, and pressures onto the orbital floor and the medial orbital wall were measured. On preoperative computed tomographic images taken in the same 20 patients, the superior and lateral bulges of the orbital floor and medial orbital wall were measured, respectively. The measurements were done on the unaffected sides. Consequently, the pressure onto the orbital floor was significantly higher in the orbital floor fracture models than in the medial orbital wall fracture models, although the pressure onto the medial orbital wall was not significantly different between the models. As for the morphologic study, the superior bulge of the orbital floor was higher in the orbital floor fracture group than in the medial orbital wall fracture group. The results of this study indicate that since the orbital floor with a high superior bulge receives high hydraulic pressure, patients with a high superior bulge have a greater risk of orbital floor fracture.

Orbitalization of Ethmoidal Sinus With Stacked Cross-linked Acellular Dermal Matrix: A New Strategy to Reconstruct Medial Orbital Wall Fracture.

The use of an acellular dermal matrix (ADM) has not been reported in medial orbital wall fracture reconstruction previously. This study aimed to share our early experience with the cross-linked ADM as an allograft material for medial orbital wall reconstruction. In this study, the author evaluated the medical records and serial facial computed tomography scans of 27 patients with pure medial orbital wall fractures reconstructed by a single surgeon between May 2021 and March 2023. The author routinely approached the medial orbital wall with a retrocaruncular incision. Five out of 27 patients were reconstructed with trimmed, multiple folded, 1.0-mm-thick cross-linked ADM (MegaDerm; L&C Bio, South Korea). All cases reconstructed with cross-linked ADM improved clinically and radiologically without complications. The serial computed tomography findings revealed that implanted cross-linked ADM successfully covered the defect while providing a significant volumizing effect. This is the first study to show the efficacy of cross-linked ADM for orbital medial wall fracture reconstruction. Our strategy of orbitalization of ethmoidal sinus with stacked cross-linked ADM would be an excellent surgical option.

Management of Mid-Facial Fracture Complicated by Pseudoaneurysm of Posterior Superior Alveolar Artery.

Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.

Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

Objectives: The aim of the current study was to determine whether, using the Hess area ratio for an objective measurement of ocular motility, orbital blowout fractures should be surgically repaired. Methodology: 200 consecutive patients with ocular fractures were involved in this retrospective analysis (mean age: 27.0 years; range: 7-65 years; 150 males; 50 females). Between March 2009 and September 2017, all patients received an orbital fracture diagnosis at the Zia Uddin Hospital in Karachi, Pakistan's Department of Maxillofacial Surgery. All patients had surgery to correct the problem within 30 days of their diagnoses, and they were all monitored for at least three months afterward (mean follow-up time: 7.3 months; range: 4-60 months). Results: Out of the 200 instances, 155 patients (77.5%) had fractures of the orbital floor, 31 (15.5%) had fractures of the medial orbital wall, and 14 (7%) had fractures of both the medial and lateral orbital walls. In addition, 132 patients had fractures of the orbital depressed fragment, 58 had fractures of the orbital trap-door with imprisoned tissue, and 10 had fractures of the orbital trap-door with muscle entrapment.

Large Medial Orbital Wall Fracture in the Setting of Prior Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is performed as a treatment for refractory sinusitis. Ethmoidectomy is a component of FESS. In performing ethmoidectomy, the septa that are believed to buttress the medial orbital wall are removed. The impact of endoscopic sinus surgery upon orbital biomechanics have been studied in a cadaver model. These studies have demonstrated increased likelihood of medial orbital wall fracture in a cadaver model. In this report, the authors present the case of a patient who sustained facial trauma with a history of prior FESS. She developed a large medial orbital wall fracture and nondisplaced floor fracture. Reconstruction was successfully performed with an alloplastic implant. Despite increasing numbers of FESS operations performed, there is limited evidence in the literature regarding orbital fracture in patients with a history of FESS. This case provides support for the findings of the recent cadaver studies.

Surgical Approaches to Orbital Fractures: A Practical and Systematic Review.

A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms "orbital," "wall," "fracture," and "surgery" with different combinations. A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, P < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, P < 0.0001). The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.

The Impact of Orbital Volume on Post-traumatic Enophthalmos: A Systematic Review and Meta-analysis.

Orbital volume increase has been previously linked with post-traumatic enophthalmos. However, this varies and some studies show no correlation. This systematic review and meta-analysis aimed to synthesize the correlation between orbital volume and enophthalmos and to determine if surgical intervention, enophthalmos measurement method, fracture location, or timing affect this correlation. Automation tools were used to assist in this review of 6 databases. Searches were performed across all dates. Included studies quantitatively reported orbital volume and enophthalmos following traumatic orbital wall fractures in at least 5 adult subjects. Correlational data were extracted or calculated. Random-effects meta-analysis was used with subgroup analyses for each of the secondary aims. Twenty-five articles describing 648 patients were included. The pooled correlation between orbital volume and enophthalmos was r =0.71 ( R2 =0.50, P <0.001). Operative status, enophthalmos measurement method, and fracture location did not affect pooled correlation. The delay between trauma or surgery and enophthalmos measurement was not shown to modulate correlation for unoperated patients ( R2 =0.05, P =0.22) but showed a negative relationship for postoperative patients ( z =-0.0281, SE=0.0128, R2 =0.63, P =0.03), but this was heavily influenced by a single article. All results had high residual heterogeneity. Studies were rated as moderate, low, or very low quality with few stating explicit hypotheses or limitations. Bony orbital volume expansion accounts for around 50% of post-traumatic enophthalmos. The other half is probably explained by soft tissue or geometric bony, rather than volumetric, changes.

Orbital wall restoration with primary bone fragments in complex orbital fractures.

Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration technique in which the primary orbital wall fragments were restored to their prior position in complex orbital fractures in 2020. As a follow-up to a previous preliminary study, this study retrospectively reviewed the surgical results of complex orbital wall fractures over a 4-year period and compared the surgical outcomes by dividing them into groups with and without balloon restoration. Data of 939 patients with facial bone fractures between August 2018 and August 2022 were reviewed. Of these, 154 had complex orbital fractures. Among them, 44 and 110 underwent reduction with and without the balloon technique respectively. Pre- and postoperative Naugle exophthalmometer (Good-Lite Co.) scales were evaluated. The orbital volume and orbital volume ratio were calculated from preoperative and 6 months postoperative computed tomography images. Among 154 patients with complex orbital fractures, 44 patients underwent restoration with the balloon technique, and 110 patients underwent restoration without it. The Naugle scale did not differ significantly between the two groups, but the orbital volume ratio significantly decreased by 3.32% and 2.39% in groups with and without the balloon technique and the difference in OVR was significantly greater in patients in the balloon restoration group compared with the control group. Postoperative balloon rupture occurred in six out of 44 cases (13.64%). None of the six patients with balloon rupture showed significant enophthalmos at 6 months of follow-up. The balloon rupture rate was 13.64% (6/44 cases) with marginal screw fixation, blunt screws, and extra protection with a resorbable foam dressing. Furthermore, we restored the orbital wall with primary orbital fragments using balloon support in complex orbital wall fractures.

Effectiveness of Cross-Linked Acellular Dermal Matrix to Correct Post-Traumatic Enophthalmos.

The use of an acellular dermal matrix is rarely reported in orbital wall fracture reconstruction. This study aimed to share the author's experience with the cross-linked acellular dermal matrix as an allograft material for enophthalmos correction. In this retrospective study, the author evaluated the medical records and 3-dimensional facial computed tomography scans of patients with enophthalmos caused by neglected orbital fractures between May 2021 and June 2022. Facial computed tomography scans confirmed the clinical diagnosis of enophthalmos. A single surgeon performed all surgical operations. In all patients, the author accessed the orbital floor via subciliary incision while approaching the medial wall with a retrocaruncular incision. After fully exposing the lesion, the author used a 1.0-mm-thick cross-linked acellular dermal matrix (ADM) (MegaDerm; L&C Bio, South Korea). After trimming the cross-linked ADM to a proper size, the author implanted the ADM into the lesion. During May 2021 and June 2022, 3 cases of enophthalmos were successfully corrected with cross-linked ADM at the author's hospital. All patients were improved clinically and radiologically. This is the first study to show the effectiveness of cross-linked ADM for the correction of enophthalmos.

A Profile of Ocular Trauma Cases Visiting the Ophthalmology Department in a Tertiary Care Eye Centre

Ocular trauma is a significant preventable cause of permanent visual morbidity and has a substantial socioeconomic impact. Hence, it is essential to understand the various causes, presentations, treatment and surgical approaches with regards to the treatment of these cases as well as prevention with safety devices. This paper aims to assess pattern of presentation and risk factors of ocular injuries attending the department of ophthalmology a tertiary care center. This was a retrospective analysis of ocular trauma cases that visited our center between 2018 to 2021 and the various diagnostic techniques and appropriate surgical methods taken with respect to each case, highlighting the visual outcome. A follow-up was maintained in all cases for three years at regular 3-4 months interval. It was found that 50% of injuries were open-globe injuries, 16.7% closed globe injuries and 25% orbital wall fractures. Majority of subjects were in the age group 21-30 years (41.7%) of which 83.3% males. The most common cause of ocular injury was road traffic accidents (66.7%) of which 37.5% were associated with two-wheeler vehicles. 41.6% presented with visual acuity less than 6/60. 83.3% required surgical treatment. 58.2% of eyes regained visual acuity greater than or equal to 6/24 of which 25% regained visual acuity of 6/9. In conclusion, ocular trauma was more common in males following road-traffic accidents particularly with two-wheeler, the majority presenting immediately following the trauma and most required surgical correction.

Strabismus in pediatric orbital wall fractures.

To assess the clinical profiles and outcomes of strabismus in pediatric patients with orbital wall fractures. A retrospective interventional study of all consecutive children of age ≤16 years who presented with traumatic orbital wall fractures with and without resultant strabismus was conducted. The details of patient demographics, clinical features, interventions, and outcomes were obtained. Forty-three children presented with traumatic orbital fractures to a tertiary care center. The mean age at presentation was 11 years and there was a male predominance (72.09%). Isolated floor fracture involvement was the most common (n = 24, 55.81%), and almost half of the children had a white-eyed or trapdoor fracture (n = 21, 48.83%). Twenty-six (60.46%) children had surgical repair of fracture(s). Manifest strabismus following orbital fracture was documented in 12 children (27.90%). Of these, an exotropia was noted in seven (58.33%), hypotropia in two (16.67%), hypertropia in one (8.33%), and esotropia in one patient (8.33%), while an exotropia with hypotropia was noted in one patient (8.33%). Restrictive nature of strabismus due to either muscle entrapment or local trauma was more commonly observed in 11/12 patients (91.66%). Primary position diplopia before orbital wall fracture repair was observed in four children and after repair was observed in two children with manifest strabismus. Four children underwent strabismus surgery post-fracture repair. An improvement in strabismus and ocular motility was noted in majority of the patients after fracture repair. The few that underwent strabismus surgery had a restrictive nature of strabismus. Trapdoor fractures and the nature of trauma in children vary compared to adults. Persistence of strabismus may be due to an excessive time interval between trauma and fracture repair or the extensive nature of trauma.

Malposition of the Resorbable Sheet in Medial Orbital Wall Fractures: Frequency and Techniques for Prevention.

The aim of this report is to discuss malposition of the resorbable sheet in medial orbital wall fractures and how to prevent this problem. After making an incision through the skin and orbicularis oculi muscle, a skin-muscle flap was elevated just superficial to the orbital septum, extending to the arcus marginalis. Dissection was extended just below the anterior lacrimal crest to increase the exposure. Fracture site in medial orbital wall was visualized. A resorbable sheet (poly- l -lactide, d -lactide sheet, 0.5-mm thickness) was trimmed and molded in an L shape, with the vertical portion used to cover the medial wall defect and the horizontal portion for stability in the orbital floor. An extended part, measuring roughly 1cm, was bent across on the infraorbital rim, and this part was fixed with absorbable screws to prevent the sheet from crumpling. After the molded plate was put in position, the periosteum and skin were closed. From 2011 to 2021, the authors operated on 152 orbital floor or medial wall fractures. Among 152 patients who underwent surgery to reconstruct orbital floor or medial wall fracture, of whom 27 patients had both floor and medial wall fractures, the authors experienced 2 cases of medial orbital wall fractures where the resorbable sheet was malpositioned, requiring reoperation. To prevent malposition of the sheet in medial wall reconstruction, the inferomedial angle of the vertical portion and the horizontal portion of the sheet should be about 135°. Before fixing the sheet on the bony part, a complete tension-free forced-duction test is mandatory.

Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature.

Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 15 June 2021 to 15 June 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect.

Prediction of Enophthalmos in Medial Orbital Wall Fracture: Suggested Coordinate Plane for Making Surgical Decisions.

Enophthalmos is one of the most distressing complications of blowout orbital fractures. Although several studies have been conducted on the topic of indications of early surgical correction, none have been performed using a set of measurable parameters. The study quantitatively examined orbital fracture areas (OFA) and volumes (OFV) retrospectively of 242 patients with isolated medial orbital wall fractures that were treated conservatively during a 12-year period (from 2009 to 2021). Three plastic surgeons measured enophthalmos >6 months after trauma. The correlations between parameters and enophthalmos in the study cohort were analyzed. In addition, patients treated operatively, and nonoperatively were compared with assess the suitability of the predictive model. Significant correlations were observed between several parameters and late enophthalmos. Total 2.59cm 2 of OFA (ie, OFA >2.59cm 2 ) or 1.45cm 3 of OFV (ie, OFV >1.45cm 3 ) corresponds to 2mm of enophthalmos. Multiple regression analysis revealed the following coefficients: -0.208 is a constant ( P <0.001), with 0.695 and 0.372 for OFA and OFV, respectively ( P <0.001 for both OFA and OFV). The study shows that enophthalmos can be more accurately predicted when OFA and OFV are simultaneously considered in patients with isolated medial wall fractures. Finally, an algorithm and a "blowout fracture coordinate plane" was proposed to aid treatment decision-making in isolated medial wall fractures.

The pattern of orbital walls fractures in north of Jordan.

The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral and maxillofacial surgery of a tertiary hospital in Jordan. A retrospective cohort study of patients with a diagnosis of with selected orbital walls fracture was designed and implemented, during a two-year period between January 2020 and December 2021. Information on patients treated for orbital walls fractures were retrieved and analyzed regarding age, sex, etiology, anatomical site, and treatment modality. Descriptive data presented as simple frequencies and percentages. A total of 76 patients with 100 orbital wall fractures, age range was 4-68 years old with a mean age 28 (SD±12), of whom were 53 (69.7%) were male and 23(30.3%) were female, with male:female ratio was 2:1. The most common etiology of all orbital walls fractures was RTA in 47 patients (61.8%; P ≤0.021), followed by violence in male patients. The most prevalent age-group was 21-30 years old with 16 patients (21.05%; P ≤0.235), and single orbital wall fractures 56 (56%) were more common than combined orbital wall fractures. In conclusion, this study will contribute to identifying the best clinical therapy and protective techniques for individuals with orbital fractures. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.

Anteroposterior Ethmoidectomy in the Endoscopic Reduction of Medial Orbital Wall Fractures: Does It Really Reduce Stability?

The surgical treatment of isolated medial orbital wall fractures is still a much-debated topic in the literature due to the choice of many surgical accesses. The main options are represented by transcutaneous versus endonasal endoscopic approaches. Our study aims to clarify the role of ethmoidectomy in the pure endoscopic endonasal reduction of medial orbital wall fractures, evaluating the immediate postoperative outcome and its long-term stability. A total of 31 patients affected by isolated medial orbital wall fracture, treated only by endoscopic approach, were included in the study and divided in two groups: (A) 14 patients treated by endoscopic reduction and anterior ethmoidectomy; (B) 17 patients treated by endoscopic reduction and anteroposterior ethmoidectomy. Perioperative and 6-month postoperative follow-up CT scans were performed. With the use of 3D medical software, we evaluated the comparison between the treated orbit and the mirrored contralateral orbit in the two groups, in order to observe the reduction of the fracture. Furthermore, to check the stability of reduction and to evaluate any medial orbital wall changes, we provided a comparison between the 3D CT scan orbital images of immediate postoperative CT and 6-month follow-up. Data obtained showed that the intraoperative surgical reduction was successful in all 31 cases, but it was better in Group B. Stability of the reduction at 6 months was observed in both groups without significant discrepancies. In our opinion, the endonasal endoscopic approach with ethmoidectomy represents a valid and useful technique by which to treat medial orbital wall fractures. The anatomical detail of the buttressing structures of the medial orbital wall, as the second portion of the middle turbinate, grants long-term stability of the surgical outcome.

Traumatic acute retrobulbar haemorrhage complicated with central retinal artery occlusion

AbstractPurpose: To present the vascular complications of traumatic acute retrobulbar haemorrhage and describe its management through a case report.Methods: A case report of a patient having an acute retrobulbar haemorrhage complicated with central retinal artery occlusion (CRAO).Results: A 50‐year‐old male patient exposed to blunt orbital trauma two hours prior was referred to the emergency with complaints of pain and loss of vision in the left eye. The negative light perception was noted in this eye. A tense hematoma, proptosis, ophthalmoplegia, and a non‐reactive pupil were also noted. Biomicroscopic examination, revealed corneal edema, subconjunctival haemorrhage, and chemosis. The fundus examination was not possible. Intraocular pressure (IOP) was 60 mmHg. The patient was diagnosed with acute retrobulbar haemorrhage. Computerized tomography was performed immediately showing a fracture of the left medial orbital wall and haemorrhage within the retrobulbar space. Intravenous mannitol and topical dorzolamide‐timolol associated with oral corticosteroid were administered. IOP decreased to 30 mmHg, but the patient's visual acuity did not improve. The fundus examination revealed a total CRAO confirmed by the fluorescein angiography and OCT‐A showing massive ischemic edema and occluded perimacular arterioles with interruption to the choroidal blood flow. OCT images demonstrated an increased reflectivity and thickness of the inner retina and subretinal fluid, which corresponds to the acute phase of CRAO. The time of surgical treatment was missed, and as a result, the patient missed their chance for visual recovery.Conclusions: Retrobulbar haemorrhage is a complication from ocular trauma that may cause permanent vision loss. Retrobulbar haemorrhage can potentially lead to dangerous increases in intraorbital pressure, a condition that is also described as orbital compartment syndrome. This increase in pressure is sufficient to cause vision loss, whether through direct compression of the optic nerve leading to optic neuropathy, a central retinal artery occlusion, or compression of the vessels that provide nutrition to the optic nerve.

Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut.

Detachment of the inferior oblique muscle may be necessary under certain circumstances to repair a large inferomedial orbital fracture involving the orbital strut. This study aimed to evaluate the outcomes of patients who underwent surgeries with and without inferior oblique muscle reattachment after its detachment to repair the orbital wall fractures. Forty patients who underwent repair of combined floor and medial orbital wall fracture involving the orbital strut at a single tertiary institution between January 2014 and December 2020 were reviewed. Groups 1 and 2 comprised 20 patients each, who underwent surgery with inferior oblique muscle detachment without and with reattachment, respectively, and were followed up for at least 6 months postoperatively. Enophthalmos, Goldmann diplopia test, alignment test, ocular motility test, and orbital inferomedial angle ratio were the outcome measures. Statistically significant improvement was observed in ocular motility, diplopia, and enophthalmos postoperatively at the 1- and 6-month follow-up (p < 0.01). The mean postoperative inferomedial angle ratio (102.28 ± 10.62%) was improved significantly compared with the preoperative inferomedial angle ratio (115.61 ± 4.38%) (p = 0.004) in all patients. After surgery, inferior oblique muscle underaction was observed in seven and six patients in groups 1 and 2, respectively, which was associated with preoperative extraocular movement limitation and strabismus. Two patients showed diplopia in both groups at the last follow-up; they had inferior oblique muscle underaction but no enophthalmos. Orbital fracture repair with or without inferior oblique muscle reattachment was clinically effective and safe; however, patients with preoperative strabismus and extraocular motility limitation should be informed of the increased risk of postoperative complications.

안와 외향 골절 후 시력 저하를 동반한 지연성 안와기종

Orbital emphysema is commonly associated with fractures of the orbital floor or medial wall. The air often dissipates spontaneously, but rarely can cause increased intraocular pressure and even loss of vision. It predominantly occurs with medial orbital wall fractures and is exacerbated by sneezing and nose blowing. We present a case of orbital emphysema with serious complications in which vision is affected in a 51-year-old male.

Management of Orbital Medial Wall Fracture With Endonasal Balloon.

Medial wall fracture of the orbit is a condition that requires surgical correction should the patient presents a series of signs and symptoms such as diplopia and enophthalmos. The classical external approaches for exposure like the transconjunctival or transcutaneous approach have been replaced in specific cases by endoscopic approaches as they are less invasive and they eliminate any risk of potential scarring. Larger defects where the medial wall is comminuted or bony fragments are missing could be reconstructed with permanent autogenous or alloplastic materials. When bony fragments are present, a reduction of the fracture can be performed instead, with only a temporary alloplastic material for support. In this study, the authors discuss our experience regarding the management of orbital medial wall fractures by endoscopic endonasal balloon in 14 patients and describe its indications and contraindications. The authors concluded that the balloon achieves satisfactory mechanical support for the fracture to heal and it can be easily removed on an outpatient basis.