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Endoscopically Assisted Reconstruction of Orbital Medial Wall Fractures.

Chen, Chien-Tzung M.D.; Chen, Yu-Ray M.D.; Tung, Tung-Chain M.D.; Lai, Jui-Ping M.D.; Rohrich, Rod J. M.D.
Plastic & Reconstructive Surgery:

: Learning Objectives: After studying this article, the participant should be able to: 1. Describe the symptoms and signs of the orbital medial wall fractures. 2. Identify the surgical indications of the orbital medial wall fractures. 3. Differentiate the advantages and disadvantages among various surgical approaches to the orbital medial wall.

: Traditional surgical approaches to orbital medial wall fractures are either direct extraocular skin incisions or indirect bicoronal flap. However, these methods can leave remarkable orbital scars or scalp alopecia with the possible associated complications. A minimally invasive endoscopic technique with the assistance of a 2.7-mm, 30-degree telescope through a medial transconjunctival incision has been successfully used to reconstruct the orbital medial wall fractures.

This technique was applied to four patients who had orbital medial wall fractures. Three patients also had concomitant orbital floor fractures. The other had associated superior orbital fissure syndrome. All patients were presented with limited eye movement, positive forced duction test, horizontal diplopia, and enophthalmos (3 mm to 6 mm) preoperatively. The entrapped periorbital tissues in the ethmoid sinus were completely reduced endoscopically. The bone defect of orbital medial wall was reconstructed with autogenous rib bone grafts under endoscopic control.

The patients were followed up for 8 to 16 months with an average of 11 months. Three patients recovered completely without any residual eye symptoms after intervention. Clinically significant residual enophthalmos of 3 mm occurred in the patient with the superior orbital fissure syndrome. His eye movement limitation caused by entrapment of medial rectus muscle was relieved postoperatively. There was no donor-site morbidity or any complications related to the endoscopically assisted procedure.

Endoscopically assisted medial transconjunctival approach to the orbital medial wall fractures is an excellent adjunct for the exposure and complete reduction of herniated periorbital tissue and bony reconstruction of the medial orbital wall. (Plast. Reconstr. Surg. 103: 714, 1999.)

(C)1999American Society of Plastic Surgeons