Download PDF
Facial Plast Surg 2009; 25(1): 003-007
DOI: 10.1055/s-0028-1112225
© Thieme Medical Publishers

Endoscopic Transnasal Approach for Treatment of the Medial Orbital Blowout Fracture Using Nasal Septum Graft

Carlos R. Ballin1 , Luiz C. Sava1 , Carlos A.S. Maeda1 , Gustavo F. Nogueira1 , Yasser Jebahi1 , Henrique W. Sava2 , Karyn R.J Koladicz2
  • 1Ear, Nose, and Throat Department of Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
  • 2Medical Student of Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
Further Information

Publication History

Publication Date:
10 February 2009 (online)

    Permissions and Reprints

ABSTRACT

We present the experience of the Ear, Nose, and Throat Department of Santa Casa de Misericórdia de Curitiba and Hospital Universitário Cajuru PUC-PR in the transnasal endoscopic approach to medial orbital blowout fractures using nasal septum grafts. Seventeen patients have undergone endoscopic repair since June 2005, and septum grafts were used to maintain the orbital contents in position. All 17 patients were treated with this method. Two patients had diplopia on immediate postoperative evaluation. This symptom was corrected with orthoptic exercises in one patient, and the other had a little residual diplopia. Postoperative computed tomography scans showed anatomic reduction in 14 of 17 cases. There were no complications in these surgeries. The transnasal endoscopic approach is a reasonable method for the treatment of medial orbital blowout fractures. Use of septum graft is another surgical alternative for this technique.

KEYWORDS

Orbital blowout - endoscopic - septal graft

REFERENCES

  • 1 Burm J S, Chung C H, Oh S J. Pure orbital blowout fractures: new concepts and importance of medial orbital fracture.  Plast Reconstr Surg. 1999;  103 1839-1849
    CrossrefPubMedGoogle Scholar
  • 2 Jones D E, Evans J NG. “Blow-out” fractures of the orbit: an investigation into their anatomical basis.  J Laryngol Otol. 1967;  81 1109-1120
    PubMedGoogle Scholar
  • 3 Lee H M, Han S K, Chae S W, Hwnag S J, Lee S H. Endoscopic endonasal reconstruction for blowout fractures of the medial orbital walls.  Plast Reconstr Surg. 2002;  109 872-876
    CrossrefPubMedGoogle Scholar
  • 4 Chen C T, Chen Y R, Tung T C, Lai J P, Rohrich R J. Endoscopically assisted reconstruction of orbital medial wall fractures.  Plast Reconstr Surg. 1999;  103 714-721
    CrossrefPubMedGoogle Scholar
  • 5 Dodick J M, Galin M A, Kwitko M. Medial wall fracture of the orbit.  Can J Ophthalmol. 1969;  4 377-378
    PubMedGoogle Scholar
  • 6 Edwards W C, Ridley R W. Blowout fracture of medial orbital wall.  Am J Ophthalmol. 1968;  65 248-249
    CrossrefPubMedGoogle Scholar
  • 7 Thering H R, Bogart J N. Blowout fracture of the medial orbital wall with entrapment of the medial rectus muscle.  Plast Reconstr Surg. 1979;  63 848-852
    PubMedGoogle Scholar
  • 8 Leone Jr C R, Lloyd III W C, Rylander G. Surgical repair of medial wall fractures.  Am J Ophthalmol. 1984;  97 349-356
    PubMedGoogle Scholar
  • 9 Lee M J, Kang Y S, Yang Y J, Lee D Y, Chung Y Y, Rohrich R J. Endoscopic transnasal approach for the treatment of medial orbital blow-out fracture: a technique for controlling the fracture wall with a ballonn catheter and Merocel.  Plast Reconstr Surg. 2002;  110 417-426
    CrossrefPubMedGoogle Scholar
  • 10 Naraghi M, Kashfi A. Endonasal endoscopic treatment of medial orbital wall fractures via rotational repositioning.  Am J Otolaryngol. 2002;  23 312-315
    CrossrefPubMedGoogle Scholar
  • 11 Matsuo K, Hirose T, Furuta S, Hayashi M, Watanabe T. Semiquantitative correction of post-traumatic enophthalmos with sliced cartilage grafts.  Plast Reconstr Surg. 1989;  83 429-437
    PubMedGoogle Scholar
  • 12 Wiesenbaugh J, Beil M C. Orbital floor repair with nasal septal cartilage.  Trans Int Conf Oral Surg. 1973;  4 308-310
    PubMedGoogle Scholar
  • 13 Stark R B, Frileck S P. Conchal cartilage grafts in augmentation rhinoplasty and orbital floor fracture.  Plast Reconstr Surg. 1969;  43 591-596
    PubMedGoogle Scholar
  • 14 Copeland M, Meisner J. Maxillary antral bone graft for repair of orbital fractures.  J Craniofac Surg. 1991;  2 18-21
    PubMedGoogle Scholar
  • 15 Maves M D, Matt B H. Calvarial bone grafting of facial defects.  Otolaryngol Head Neck Surg. 1986;  95 464-470
    PubMedGoogle Scholar
  • 16 Converse J M, Cole G, Smith B. Late treatment of blow-out fracture of the floor of orbit: a case report.  Plast Reconstr Surg. 1961;  28 183-191
    PubMedGoogle Scholar
  • 17 Dost P. Orbitabodenrekonstruktion mit autologum periosttransplantat.  Laryngorhinootologie. 1996;  75 57-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Smith J D, Abramson M. Membranous vs. endochondral bone autografts.  Arch Otolaryngol. 1974;  99 203-205
    PubMedGoogle Scholar
  • 19 Goldman R J, Hessburg P C. Appraisal of surgical correction in 130 cases of orbital floor fractures.  Am J Ophthalmol. 1973;  76 152-155
    PubMedGoogle Scholar
  • 20 Rubin P A, Bilyk J R, Shore J W. Orbital reconstruction using porous polyethylene sheets.  Ophthalmology. 1994;  101 1697-1708
    CrossrefPubMedGoogle Scholar
  • 21 Polley J W, Ringer S L. The use of Teflon in orbital floor reconstruction following blunt facial trauma: a 20-year experience.  Plast Reconstr Surg. 1987;  79 39-43
    CrossrefPubMedGoogle Scholar
  • 22 Scapini D A, Mathog R H. Repair of orbital floor fractures with Marlex mesh.  Laryngoscope. 1989;  99 697-701
    PubMedGoogle Scholar
  • 23 Sewall S R, Pernoud F G, Pernoud M J. Late reaction to silicone following reconstruction of an orbital floor fracture.  J Oral Maxillofac Surg. 1986;  44 821-825
    CrossrefPubMedGoogle Scholar
  • 24 Morrison A D, Sanderson R C, Moos K F. The use of Silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years.  J Oral Maxillofac Surg. 1995;  53 412-417
    CrossrefPubMedGoogle Scholar
  • 25 Lai A, Gliklich R E, Rubin P A. Repair of orbital blow-out fractures with nasoseptal cartilage.  Laryngoscope. 1998;  108 645-650
    CrossrefPubMedGoogle Scholar
  • 26 Emery J M, von Noorden G K, Schlernitzauer D A. Orbital floor fractures: long-term follow-up of cases with and without surgical repair.  Trans Am Acad Ophthalmol Otolaryngol. 1971;  75 802-812
    PubMedGoogle Scholar
  • 27 Browning C W. Alloplastic materials in orbital repair.  Am J Ophthalmol. 1967;  63 955-962
    CrossrefPubMedGoogle Scholar
  • 28 Nicholson D H, Guzak S V. Visual loss complicating repair of orbital floor fractures.  Arch Ophthalmol. 1971;  86 369-375
    CrossrefPubMedGoogle Scholar

Carlos R BallinM.D. 

Adjunct Professor of Ear, Nose, and Throat of Pontifícia Universidade Católica do Paraná (PUCPR)

Curitiba, Brazil

Email: cballin@uol.com.br

      >