J Rhinol.  2019 Nov;26(2):65-74. 10.18787/jr.2019.26.2.65.

Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

• Shim WS
• Jung HJ

• KMID: 2465536
• DOI: http://doi.org/10.18787/jr.2019.26.2.65

Abstract

Orbital blowout fracture is a common result of facial trauma and is observed more frequently now than in the past as a result of introduction of computed tomography and increased incidence of high-energy impact injuries. Because orbital fracture may be associated with prolapse of the orbital contents into the paranasal sinuses, which results in sequelae such as diplopia and enophthalmos, proper diagnosis and timing of repair are crucial. However, clinical decision-making in the management of patients with orbital blowout fractures is challenging, and various aspects of orbital fracture management are uncertain. Numerous approaches have been used for reduction of blowout fracture. Controversies exist regarding indications for surgery, timing of surgery, and optimal reconstruction material. Recently, with expanding use of and indications for endoscopy in orbital blowout fracture surgery, otolaryngologists participate more often in facial trauma surgery, including blowout fracture. In this review, several controversial issues of surgical indication, surgical timing, method of approach, and choice of reconstruction material are discussed from the perspective of otolaryngology surgeons.

Keyword

Trauma; Orbital fracture; Orbital blowout fracture; Enophthalmos; Diplopia

MeSH Terms

Clinical Decision-Making
Diagnosis
Diplopia
Endoscopy
Enophthalmos
Humans
Incidence
Methods
Orbit*
Orbital Fractures
Otolaryngology
Paranasal Sinuses
Prolapse
Surgeons

Figure

• 

  Fig. 1 Facial bone CT scan images of medial blowout fracture. A: Preoperative images. B: Postoperative images (arrow: glove with Merocel®).

• 

  Fig. 2 Transconjunctival approach for inferior blowout fracture. A: conjunctival incision using Colorado needle tip, along the inferior border of the tarsal plate from not extending medially to the punctum with two traction sutures. B: dissection toward the orbital rim, between the orbital septum and orbicularis oculi muscle. C: periosteal incision at the inferior orbital rim. D: subperiosteal dissection and reduction of herniated orbital tissue. E: implant design (Medpore®). F: insertion of the implant, at least 3 sides of the implant should be laid over the fracture margin.

• 

  Fig. 3 Facial bone CT scan images of inferior blowout fracture. A: Preoperative images. B: Postoperative images (arrow: reconstruction material, Medpore®).

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