Endoscopic intranasal reduction of the orbit in isolated blowout fractures.
CONCLUSIONS
Endoscopic intranasal reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel packing, provided good functional results and definite advantages. We suggest that these techniques are another surgical alternative for isolated orbital floor or medial wall blowout fractures that do not accompany any associated fractures of the orbital rim.


OBJECTIVE
Extended applications of endoscopic sinus surgery have reported endoscopic intranasal reduction or reconstruction of the orbital wall with good functional and cosmetic results. We present our experience with endoscopic intranasal reduction of the orbit in isolated orbital floor and/or medial wall blowout fractures, treated by reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel packing.


METHODS
Floor reduction: After creating a wide middle meatal antrostomy, herniated orbital contents and fracture-displaced floor are mobilized and reduced. The orbital floor is supported by a saline filled balloon, which is connected with an infant feeding catheter and passed through the middle meatal antrostoma. After confirming the reduction of the orbital floor by postoperative CT, the catheter is ligated and cut in short to keep it in the nasal cavity. Medial wall reduction: After completing an intranasal ethmoidectomy, herniated orbital contents and fractured lamina papyracea are mobilized and reduced. The shape of the medial orbital wall is fixed by a silastic sheet and Merocel packing saturated with an antibiotic solution. Surgery was performed when the eye function could be accurately assessed, usually at 7 to 10 days following the injury. Temporary supporting of the orbital wall with a detachable temporary balloon, or a silastic sheet and Merocel packing was removed 4 weeks after surgery in the out-patient clinic.


RESULTS
We have experienced 40 cases of endoscopic intranasal reduction of the orbit in blowout fractures. CT scan confirmed isolated orbital floor fracture in 11 patients, isolated medial wall fracture in 17 patients, and combined fractures of the orbital floor and the medial wall in 12 patients. Twenty five patients had diplopia, 20 patients had limitation of eye movement, and 14 patients developed enophthalmos. Thirty three of the 40 patients recovered completely without any residual eye symptoms or complications.
Jeon
Sea-Yuong
SY
Department of Otolaryngology, Gyeong-Sang National University Hospital, Chinju, Korea. syjeon@nongae.gsnu.ac.kr
Kwon
Jae Hwan
JH
Kim
Jin Pyeong
JP
Ahn
Seong Ki
SK
Park
Jung Je
JJ
Hur
Dong Gu
DG
Seo
Seong Wook
SW
D000293:Adolescent; D000328:Adult; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage; D004172:Diplopia / Q000209:etiology; D004724:Endoscopy; D015841:Enophthalmos / Q000209:etiology; D005260:Female; D005557:Formaldehyde / Q000008:administration & dosage; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology; D009915:Orbit / Q000601:surgery*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D011183:Postoperative Complications; D012828:Silicones / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
D004129:Dimethylpolysiloxanes; D006490:Hemostatics; D012828:Silicones; D005557:Formaldehyde; C027490:polyvinyl alcohol formaldehyde foam; C013830:baysilon; D011142:Polyvinyl Alcohol