Endoscopic repair of isolated orbital floor fracture with implant placement

This study was designed to assess the use of the endoscopic transmaxillary approach to correcting orbital blowout fractures (OBFs) with placement of alloplastic implants.

This was a prospective study of patients treated in the Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville over a 6-month period, July to December 2005. Ten patients (7 males, 3 females, age range 19 to 47 years [average age 37.3 years]) met the inclusion criteria for the study and consented to undergo surgical repair. The injury was most commonly secondary to assault (6 cases); the remainder were secondary to motor vehicle collisions. The time from injury to correction ranged from 3 to 36 days (average, 10.9 days). A computed tomography scan with axial and coronal views was obtained in each patient at the time of presentation. All patients who met the inclusion criteria for the study underwent an endoscopic-assisted transmaxillary repair of their OBF with placement of a Medpor implant (Porex Surgical Products, Newnan, GA).

Of the 10 patients, 9 presented with diplopia preoperatively and 4 had associated entrapment on upward gaze. One patient did not have entrapment or diplopia but had a fracture larger than 2 cm(2). All patients underwent successful OBF repair with placement of a Medpore implant through the endoscopic transmaxillary approach, and all experienced resolution of preoperative diplopia and/or entrapment. None of the patients developed enophthalmos at a mean follow-up of 12.7 weeks.

The endoscopic transmaxillary approach to correcting OBF is an excellent alternative to the transconjunctival approach. This approach carries a very low morbidity and may be used in circumstances in which conventional approaches are not feasible.