Endoscopic repair of orbital blowout fractures

概要

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We reviewed cases of orbital blow-out fracture, which were endoscopically operated upon in our institution in the 1990s (229 cases). When diplopia and/or disturbed eye movement could not be improved after one week's conservative treatment, we performed endoscopic surgery as follows. Fracture of the lamina papyracea was repaired endonasally and fixed with a silicone plate and gauze packing. Fracture of the orbital floor was repaired either endonasally or trans-maxillarily and fixed with a balloon catheter. In the case of surgery performed under local anesthesia, improvement of the patient's complaints was able to be confirmed even during the surgery. However, when we have to perform surgery under general anesthesia, such as in a child, sufficient removal of the fractured bone as well as the traction test during surgery is needed. Post-operative improvement was evaluated on the bases of an ophthalmologic examination and the change in the patient's subjective symptoms. In about 90% of all cases, a good clinical course was achieved. When the fracture occurred in a narrow area, so that the intra-orbital content was got between fractured bones, the post-operative improvement tended to be insufficient. We, therefore, concluded that the prognosis after the operation depends, to some extent, on the severity of the injury to the orbital content at the time of the injury.
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