Endoscopically assisted repair of orbital floor fractures

Traditionally, orbital floor fractures are repaired with standard transcutaneous or transconjunctival approaches. Complications such as external scarring, eyelid edema, ectropion, entropion, and granuloma formation have been associated with these open lid techniques. The endoscope has been used to assist in orbital floor exploration, to reduce entrapped orbital tissue, and to identify the posterior shelf for implant placement. However, an open lid incision is inevitable when implant placement is necessary. We present our experiences in repairing orbital floor fractures using transantral endoscopy without open lid incision.A 0-degree, 4-mm endoscope was placed through a 2 x 1.5-cm2 maxillary antrostomy to dissect the sinus roof. The endoscope was used to assist in the reduction of the floor fractures and prolapsed orbital tissue into the orbital cavity, if present. The orbital floor defect was reconstructed with titanium mesh or Medpor through the antrostomy under endoscopic control. This technique was applied to nine patients who had orbital floor fractures. Two of the patients had zygomatico-orbital fractures, whereas the rest had isolated orbital floor fractures. Three patients received Medpor reconstruction and the remaining six underwent titanium mesh reconstruction. The patients were followed up for 10 months on average. The enophthalmos was corrected in all patients but one, who suffered from mild enophthalmos because of uncorrected orbital medial wall fractures. Diplopia occurred in three patients preoperatively, which was resolved in two of them and improved in the other postoperatively. There have been no complications apart from transient anesthesia in the dermatome of the infraorbital nerve. The technique successfully reconstructed the orbital floor defects, minimized ocular globe manipulation, and eliminated a lower eyelid incision.