The Postoperative Results of Endoscopic Transnasal Approach to Blowout Fractures

Nam, Su Bong; Kim, Kyoung Hoon; Choi, Soo Jong; Lee, Min Woo; Bae, Yong Chan

Abstract

PURPOSE: Many surgical approaches for reconstruction of blowout fractures have been used, which include subciliary incision, transconjunctival incision, medial canthal incision and an endoscopic approach recently attempted, etc. The aim of this study was to demonstrate a surgical technique of endoscopic transnasal approach and to investigate the result & availability of endoscopic transnasal approach with or without subciliary incision for reconstruction of various blowout fractures.
METHODS
Between March 2004 and August 2006, 106 patients, followed up at least 6 months, were treated through endoscopic transnasal approach with or without subciliary incision for reconstruction of the blowout fractures. All patients were operated under general anesthesia. In case of medial blowout fractures, we confirmed the size and the location of the fragmented medial orbital wall by identifying the herniation through the transnasal endoscope by pressing the affected eyeball. after reduction of herniated orbital tissue with periosteal elevators, a silastic sheet(1-mm thickness) and Merocel(R) packing were applied. In case of inferior blowout fractures, we identified the size and the location of the fragmented orbital wall through subciliary incision and inserted 1.6mm Medpor(R), and required the combined use of endoscope and the ballooning of a foley catheter.
RESULTS
Most patients showed the improvement of preoperative symptoms. However, in patients with extensive medial and inferior blowout fracture, the complications such as diplopia, enophthalmos larger than 2mm, and limitation of extraocular motions had remained after operation. Ectropion, conspicuous scar, the protrusion or resorption of the alloplastic implants were not observed.
CONCLUSION
In conclusion, a transnasal endoscopic correction may be considered a useful method for surgical repair of various blowout fractures, with excellent visualization and accuracy comparable to that of the subciliary approach.