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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2010 December;21(3):133-8
Orbital medial wall fractures: diagnosis and treatment
Belli E. 1, Mazzone N. 2, Rendine G. 3
1 Department of Maxillo Facial surgery, II Faculty of Medicine and Surgery, La Sapienza University, Sant’Andrea Hospital
2 Speciality School of Maxillo Facial Surgery, La Sapienza University, Rome, Italy
Aim. In the last thirty years, diagnostical imaging, surgical techniques, alloplastic materials, and surgical instruments development, have allowed a great progress in management of orbital fractures. The aim of the present study is to focus on the progress and changes in the management of orbital medial wall fractures.
Methods. Between 2005 and 2009, 11 (8 males, 3 females) consecutive patients with isolated medial orbital wall fractures were managed by authors (mean age 37.6 years, range 9-79 years). A patient presented with an outcome fracture, and was treated by the reconstruction of the medial orbital wall using the nasal septum cartilage. In patient with functional impairments, surgery was performed within 6 days. Surgery was performed under general anesthesia after topical infiltration with carbocaine with adrelanine. Endoscopic transnasal approach was performed by 0 or 45 degrees; 4-mm diameter endoscope was used. The medial wall was approached through the ethmoid cavity. Uncinectomy and enlargement of aditus ad antrum were performed, later exposure of ethmoidal cells was allowed by bulla opening.
Results. No significant intraoperative or postoperative complications were detected in the sample. Transient mild orbital pain decreased over time. Patients were dismissed one day after surgery. Diplopia and enophthalmos measurements 3 months after surgery were compared with preoperative measurement. Statistically significant improvement was observed.
Conclusion. Endoscopy has an advantage of excellent visualization of the medial and inferior walls of the orbit, which enables safe removal of bony fragments and clear anatomic reduction of fractures; it virtually eliminates the risk of facial scarring and eyelid complications.