Endoscopic Transmaxillary Reduction and Balloon Technique for Blowout Fractures of the Orbital Floor

Abstract

The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

Key words

Endoscope - blowout fracture - transmaxillary reduction - maxillary balloon technique

References

• 1 Converse J M, Smith B. Enophthalmos and diplopia in fracture of the orbital floor.  Br J Plast Surg. 1957;  9 265-274
• 2 Johnson M R. Depressed fracture of the orbital rim.  Surg Clin N Am. 1944;  24 340-347
• 3 Miki T, Haraoka J, Inaba I, Utsumi T. Maxillary antral balloon technique for blowout fracture.  Neurotraumatology. 2001;  24 57-62
• 4 Puttermann A M, Stevens T, Urist M J. Nonsurgical management of blowout fracture of the orbital floor.  Am J Ophthalmol. 1974;  77 232-239
• 5 Saunders C J, Whetzel T P, Stokes R G, Wong G B, Stevenson T R. Transantral endoscopic orbital floor exploration: A cadaver and clinical study.  Plast Reconstr Surg. 1997;  100 575-581
• 6 Smith B, Regan W F. Blowout fracture of the orbit.  Am J Ophthalmol. 1957;  44 733-739
• 7 Sugamata A, Watanabe K, Nomoto T. Clinical evaluation of new operative indication for orbital blowout fracture.  J Soc Cranio-maxillo-facial Surg. 2000;  16 54-61
• 8 Sugamata A, Makino K. Clinical study of blowout fracture.  J Jpn P R S. 1992;  12 307-319
• 9 Converse J M, Smith B, Obear M E, Wood-Smith D. Orbital blowout fracture: a ten-year survey.  Plast Reconstr Surg. 1967;  39 20-35
• 10 Caldwell G W. Disease of the accessory sinuses of the nose, and an improved method of treatment for suppuration of the maxillary sinus.  NY Med J. 1893;  58 526-528
• 11 Luc H. Nouvelle method operation pour la cure radicale et rapide de l'empyeme choronique du sinus maxillaire.  Bull Med Soc Fr. 1897;  457-458
• 12 Otori N, Haruna S, Moriyama H. Endoscopic endonasal or transmaxillary repair of orbital floor fracture: A study of 88 patients treated in our department.  Acta Otolaryngol. 2003;  123 718-723
• 13 Egbert J E, May K, Kersten R C, Kulwin D R. Pediatric orbital floor fracture. Direct extraocular muscle involvement.  Ophthalmology. 2000;  107 1875-1879
• 14 Ogawa K, Kohzu N, Sakatsume M, Ohotsuki K, Sato S, Imaizumi H. Antral balloon technique for treatment of the malar bone and blowout fracture.  J Oto-Laryngol Jpn. 1978;  81 487-499
• 15 Bahr W, Bagambisa F B, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: A retrospective study.  Plast Reconstr Surg. 1992;  90 585-591
• 16 Lorenz H P, Longaker M T, Kawamoto Jr H K. Primary and secondary orbit surgery: The transconjunctival approach.  Plast Reconstr Surg. 1999;  103 1124-1128
• 17 Mullins J B, Holds J B, Branham G H, Thomas J R. Complications of the transconjunctival approach. A review of 400 cases.  Arch Otolaryngol Head Neck Surg. 1997;  123 385-388
• 18 Chen C T, Chen Y R. Endoscopic assisted repair of orbital floor fractures.  Plast Reconstr Surg. 2001;  108 2011-2019