Endoscopic repair of combined orbital floor and medial wall fractures involving the inferomedial strut.

OBJECTIVES

To evaluate the safety, efficacy, and feasibility of an endoscopic transconjunctival inferior fornix and precaruncular approach for repair of combined orbital medial wall and floor fractures involving the inferomedial strut.

METHODS

A retrospective study was performed in 84 patients with combined orbital medial wall and floor fractures involving the inferomedial strut. All patients underwent surgery by endoscopic transconjunctival inferior fornix and precaruncular approach. A large polyester mesh plate was implanted to cover the fracture defect. The enophthalmos, diplopia, and surgical complications were evaluated pre- and postoperatively. Patients were followed for at least 6 months.

RESULTS

A total of 84 patients (55 men and 29 women) with a mean age of 36.88 ± 12.95 years were included in this study. Preoperatively, all 84 patients had an enophthalmos >2 mm, and the mean exophthalmometry measurement was 11.6 ± 2.14 mm. Diplopia was presented in 33 patients. Postoperatively, good symmetry was acquired in 81 of 84 patients, with a mean improvement of 3.02 ± 0.99 mm in the enophthalmos (P < 0.05). Recovery from diplopia occurred in 32 of 33 patients. A new onset of diplopia occurred postoperatively in 13 of the remaining 51 patients, only to recover spontaneously after 1 month. One patient suffered retrobulbar hemorrhage after surgery and was cured by conservative therapy. No other serious complications occurred.

CONCLUSIONS

The endoscopic transconjunctival inferior fornix and precaruncular approach is a promising management technique for combined orbital medial wall and floor fractures involving the inferomedial strut.