[Isolated medial orbital wall fractures: results of minimally invasive endoscopically controlled endonasal surgical technique].

Between 1991 and 1993, 9 cases of isolated medial orbital wall fractures were diagnosed with 8 patients, 8 of them complaining of horizontal diplopia due to medial rectus muscle entrapment. An endoscopic-controlled endonasal surgical procedure was performed in 7 patients. The endonasal procedure provided adequate exposure for removal of the incarcerated tissue as well as covering the defect. All 7 patients had good results with no restriction of lateral gaze and There were no surgical complications observed. The first step of the endonasal technique is a partial resection of the middle turbinate. During the following partial ethmoidectomy, the fracture of the ethmoid and medial orbital wall are exposed. This must be done carefully while avoiding any trauma to the herniated orbital contents. After repositioning the orbital fatty tissue, lyodura is introduced and fixed with fibrin glue. For larger defects, free graft of mucosa is recommended. The nasal packing is done between two silicon sheets in order to simplify the removal after 8 days. All 7 patients proved to be free of motility disturbances after the intervention. The endonasal method is limited to isolated medial wall fractures; in all other cases of midfacial fractures combined techniques have to be used.