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Functional and Aesthetic Outcome of Extensive Orbital Floor and Medial Wall Fracture via Navigation and Endoscope-assisted Reconstruction

Yang, Jia-Ruei, MD*; Liao, Han-Tsung, MD, PhD†‡

doi: 10.1097/SAP.0000000000001700
Head and Neck Surgery
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Background and Purpose Extensive orbital floor and medial wall fractures compared with isolated orbital wall fractures are more likely to require surgical correction because of a higher possibility of complications like diplopia, enophthalmos, or numbness. The unique and complex contours of the orbital anatomy limit the intraoperative view of the intraorbital anatomy, and complex orbital fractures involving the buttress of the transition zone area all make orbital reconstruction surgery more challenging. The aim of this study was to describe our experience with surgical approaches using navigation- and endoscope-assisted guidance for extensive orbital floor and medial wall fracture reconstruction.

Patients and Methods A retrospective study was conducted on consecutive 17 patients from 2015 to 2017 presenting with unilateral extensive orbital floor and medial wall fractures at the Chang Gung Memorial Hospital, Linkou Branch. The fractures were treated surgically with a preformed mesh plate and layered Medpor (Porex Surgical Inc, Atlanta, Ga) through navigation and endoscopy. The preoperative and postoperative functional and aesthetic outcomes were described.

Results All extensive orbital floor and medial wall fractures were successfully reconstructed. Of the 17 patients, 11 experienced diplopia preoperatively, and for 2 of the 11 patients, diplopia improved immediately after surgery. In the remaining 9 patients, diplopia still persisted after surgery; however, diplopia recovered after an average of 3.44 months (range, 1–9 months). Average enophthalmos among the 10 patients, evaluated by postoperative follow-up computed tomography scan, improved from 2.99 to 0.68 mm. There were no major complications during follow-up, and all patients were satisfied with their final appearance and function.

Conclusions On the basis of the results, our surgical approach using preformed titanium mesh plates and Medpor under the assistance of navigation and endoscopy can be a safe, accurate, and effective method for the management of extensive orbital floor and medial wall fractures and clearly optimizes functional and aesthetic outcomes.

From the *Department of Surgery, Chang Gung Memorial Hospital;

Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; and

Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.

Received September 10, 2018, and accepted for publication, after revision September 21, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Han-Tsung Liao, MD, PhD, Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5 Fuxing Street, Taoyuan 333, Taiwan. E-mail: lia01211@gmail.com.

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