Saha Mehul, Kudva Adarsh, Gadicherla Srikanth, Aramanadka Chithra, Singh Anupam, Varshney Surbhi
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India.
J Maxillofac Oral Surg. 2025 Feb;24(1):144-152. doi: 10.1007/s12663-024-02386-z. Epub 2024 Nov 23.
Perfect reduction and fixation of orbital blowout fractures remain challenging due to difficulty in visualization of herniated orbital contents and intact bony ledge. This often leads to eyeballing during surgery, which results in inadequate soft tissue reduction or improper implant placement. The use of endoscopy greatly overcomes these challenges.
In this paper, the authors have described 3 clinical scenarios where a combined approach of open reduction and transantral endoscopy (through an anterolateral wall defect of the maxillary sinus or Caldwell-Luc procedure) has been used for the reduction and fixation of orbital floor fractures with soft tissue entrapment. This approach has ensured perfect soft tissue reduction and precise implant position, which in turn have alleviated post-operative complications and improved patient symptoms.
Conventional techniques for orbital floor repair include lower lid transcutaneous or transconjunctival approaches. However, it is difficult to visualize the posterior intact bony shelf and difficult to confirm adequate herniated soft tissue reduction. Endoscopic techniques allow superior visualization of these structures. When transantral endoscopy is combined with a traditional open approach, it provides better illumination, visualization, and effective reduction and fixation of large defects with a provision for confirmation post-fixation. In the presence of a concomitant anterolateral wall of maxillary sinus fracture, an endoscope can be easily introduced into the sinus for better visualization and confirmation. The authors have also set down a few guidelines for approaching orbital floor fractures with the combined technique in the form of an algorithm. This algorithm can help surgeons decide which type of approach to adopt based on certain characteristics of the fracture.
The combination of open reduction and transantral endoscopy is easy, effective, and shows promising results for orbital floor repair.
由于难以可视化眶内容物疝出和完整的骨壁，眼眶爆裂性骨折的完美复位和固定仍然具有挑战性。这常常导致手术过程中凭经验操作，从而导致软组织复位不充分或植入物放置不当。内窥镜的使用极大地克服了这些挑战。
在本文中，作者描述了3种临床情况，其中采用开放复位联合经鼻窦内窥镜检查（通过上颌窦前外侧壁缺损或柯-陆氏手术）来复位和固定伴有软组织嵌顿的眶底骨折。这种方法确保了完美的软组织复位和精确的植入物位置，进而减轻了术后并发症并改善了患者症状。
传统的眶底修复技术包括经下睑皮肤或经结膜入路。然而，难以可视化后方完整的骨板，也难以确认疝出的软组织是否充分复位。内窥镜技术能更好地可视化这些结构。当经鼻窦内窥镜检查与传统的开放入路相结合时，它能提供更好的照明、可视化效果，并能有效复位和固定大的缺损，且在固定后可进行确认。在上颌窦前外侧壁骨折的情况下，可轻松将内窥镜插入窦内以获得更好的可视化和确认效果。作者还以算法的形式制定了一些使用联合技术处理眶底骨折的指导原则。该算法可帮助外科医生根据骨折的某些特征决定采用哪种类型的入路。
开放复位与经鼻窦内窥镜检查相结合的方法简便、有效，在眶底修复方面显示出良好的前景。
