Clinical Research Of The Intranasal Endoscopic Assisting Transconjunctival Approach For Repairing Of Medial Orbital Blowout Fractures

Purpose: To explore the relational selection of surgical methods,operative opportunity,efficacy and superiority of endoscopicsurgery for orbital blowout fractures, we treated the medial orbitalblowout fractures by surgery and observed the recovery conditionafter operation,combining the intranasal endoscopic with thetransconjunctival approach and implanting restorative materialsduring operation.Metheds: A retrospective review was performed for isolated orbitalblowout fractures treated with the intranasal endoscopic by surgeryat the department of orbital disease and eye plastic surgery in theSecond Hospital of Jilin University between June2013and June2014. The study included28patients (28eyes) who met theinclusion criteria:19subjects were male (68%) and9were female(32%). The mean age was33.2years, raging from14to65years.The surgical repair was undergone via the transconjunctival incision.The mean date of surgery was17.4days from the date of injury,raging from6to67days from the date of injury. The remaininginjuries were due to fighting (17patients), car collisions (4patients),falls (4patients), bruises (2patients) and crush (1patient). Themedial orbital blowout fracture was diagnosed by preoperativeorbital CT (coronal and horizontal position), three-dimensional CTand MRI clearly. The routine preoperative examinations includedvision, visual evoked potentials (VEP), intraocular pressure (IOP), degree of exophthalmos, diplopia and extraocular muscle functionaltraining. During operation, the fracture area was fully exposed andthe incarcerated soft tissues (extraocular muscle and orbital fat body)surrounding the orbit fractures were subsequently restored andrecovered. Then artificial implant was trimmed according to thefracture area and the anatomi cal shape of the orbital cavity and wasinserted and fixed as a pad to fill up the defect of the orbital wall inthe surgery of reconstruction. Finally, periosteum was sutured. Theconventional anti-inflammatory and symptomatic treatment weregiven after surgery..Results: All patients’postoperative reactions were mild and noserious complications were happened. Early extraocular musclefunction trainings were adopted. All patients were clinically curedand followed up six months after surgery for monitoring vision,intraocular pressure and orbital CT scans. Orbital CT scansdisplayed fracture counterpoint to be the correct location. Artificialimplants were well fixed, with better results, no hypoglobus and norejection. The enophthalmos and eye movement were significantlyimproved compared with the preoperative. No visual loss, norejection or other adverse reactions occurred.Conclusions: Intranasal endoscopic assisting transconjunctivalapproach for repairing of medial orbital blowout fractures can be agood application in the future. This kind of treatment can be appliedunder the direct vision and in the favorable lighting conditions. Thefractures were fully exposed to supply widely operation field and toavoid serious complications. So intranasal endoscopic assistingtransconjunctival approach for repairing of medial orbital blowout fractures were well worth being clinically applied.