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Combination of Transorbital and Endoscopic Transnasal Approaches to Repair Orbital Medial Wall and Floor Fractures

Shi, Wodong MD*; Jia, Renbing MD, PhD*; Li, Zhengkang MD*; He, Dongmei MD, PhD; Fan, Xianqun MD, PhD*

Journal of Craniofacial Surgery: January 2012 - Volume 23 - Issue 1 - p 71–74
doi: 10.1097/SCS.0b013e318240c88e
Original Articles

Purpose This study aimed to illustrate the effectiveness of the combination of the transorbital and the endoscopic transnasal approach in the repair of medial wall and floor orbital fractures in Chinese patients.

Methods A retrospective study was carried out on 25 Chinese patients (18 men and 7 women) with orbital medial wall and floor fractures. All patients had enophthalmos more than 2 mm, 23 had diplopia, and 11 had eye movement restriction. Bone defect involving both medial and inferior walls was found with computed tomographic scans in all patients. In all 25 patients, surgery was done by 1 surgeon group using the transorbital and the endoscope-assisted transnasal approach. The endoscope was used to give a clear view of the posterior edge of the fracture. Titanium meshes were used to repair fractures of the orbital floor and the medial wall. Porous polyethylene sheet implants were used to recover the orbital volume. All patients were followed up 12 months after surgery.

Results Enophthalmos was corrected in all 25 patients immediately, diplopia disappeared or improved in 21 of 23 cases, and eye movement restriction was released or improved in all 11 patients. No significant complications occurred. The titanium mesh was completely covered by nasal mucosa at 1 month after surgery by an endoscopic check.

Conclusions The endoscope-assisted transnasal approach allows for excellent visualization of the extent of the fracture, particularly in areas that are difficult to visualize by conventional methods. The combination of the transorbital and the endoscope-assisted transnasal approach is a good way to reconstruct a large orbital wall fracture involving the floor and the medial wall.

From the Departments of *Ophthalmology and †Oral and Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China.

Received February 9, 2011.

Accepted for publication April 3, 2011.

Address correspondence and reprint requests to Dr. Xianqun Fan, Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China; E-mail:

This study was sponsored by Shanghai Leading Academic Discipline Project (S30205), The National Natural Science Foundation of China (30973279), The Cooperated Foundation of Medical and Engineering Science of Shanghai JiaoTong University (project no. 40YG2009ZD102), and PuJiang Talent program (project no. PJ[2009]00840).

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD