Arch Craniofac Surg.  2019 Apr;20(2):101-108. 10.7181/acfs.2019.00178.

A useful additional medial subbrow approach for the treatment of medial orbital wall fracture with subciliary technique

• Kim SM
• Kim CK
• Jo DI
• Lee MC
• Kim JN
• Choi HG
• Shin DH
• Kim SH

• KMID: 2447632
• DOI: http://doi.org/10.7181/acfs.2019.00178

Abstract

BACKGROUND
To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique.
METHODS
We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion.
RESULTS
Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion.
CONCLUSION
Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

Keyword

Dissection; Fracture fixation; Orbit; Orbital fractures

MeSH Terms

Cicatrix
Diplopia
Elevators and Escalators
Enophthalmos
Fracture Fixation
Humans
Methods
Muscles
Orbit*
Orbital Fractures
Visual Fields