Endoscopic repair of orbital blow-out fractures

Orbital floor blow-out fractures (OBFs) result from trauma to the globe and periorbita. These fractures occur in repeatable patterns that can be endoscopically classified as either medial or lateral to the infraorbital nerve (V2). Medial fractures are the most common and can be separated into "trap door" and "blow-out" fractures. Fractures that extend lateral to V2 are generally higher velocity injuries that result in comminution of the entire orbital floor. The key to successful surgical repair of these injuries is adequate exposure, visualization of the posterior bone shelf, and anatomic repair of the entire defect. Visualization of the posterior shelf can be challenging through traditional transconjunctival and subciliary approaches. These approaches also have known risks of postoperative eyelid malposition. The transmaxillary endoscopic approach to OBFs offers excellent visualization of the entire orbital floor. Fracture types can be evaluated and repaired endoscopically without the need for an eyelid incision. Although this is a new and evolving technique, early experience suggests that the endoscopic approach is a safe, efficacious technique for OBF repair. It offers improved visualization, anatomic fracture repair, no risk of postoperative eyelid complications, and good clinical results.