• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.63-70
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• 2007

The occurrence of medial orbital wall fracture is isolated or combined with other facial bone fracture. There are many complications, for example, diplopia, enophthalmos, limitation of eye movement, visual activity depression and blindness. Because of these complications, the accurate diagnosis and treatment of medial orbital wall fracture is very important. We have reconstructed medial orbital walls with transcaruncular approach and obtained good results in patients with medial orbital wall fracture.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.76-81
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• 2017

Background: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. Methods: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. Results: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. Conclusion: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.

• Archives of Craniofacial Surgery
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• v.21 no.6
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• pp.345-350
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• 2020

Background: This study evaluated the efficacy of the endoscopic medial orbital wall repair by comparing it with the conventional transcaruncular method. This surgical approach differs from the established endoscopic technique in that we push the mesh inside the orbit rather than placing it over the defect. Methods: We retrospectively reviewed 40 patients with isolated medial orbital blowout fractures who underwent medial orbital wall reconstruction. Twenty-six patients underwent endoscopic repair, and 14 patients underwent external repair. All patients had preoperative computed tomography scans taken to determine the defect size. Pre- and postoperative exophthalmometry, operation time, the existence of diplopia, and pain were evaluated and compared between the two methods. We present a case showing our procedure. Results: The operation time was significantly shorter in the endoscopic group (44.7 minutes vs. 73.9 minutes, p= 0.035). The preoperative defect size, enophthalmos correction rate, and pain did not significantly differ between the two groups. All patients with preoperative diplopia, eyeball movement limitation, or enophthalmos had their symptoms resolved, except for one patient who had preexisting strabismus. Conclusion: This study demonstrates that endoscopic medial orbital wall repair is not inferior to the transcaruncular method. The endoscopic approach seems to reduce the operation time, probably because the dissection process is shorter, and no wound repair is needed. Compared to the previous endoscopic method, our method is not complicated, and is more physiological. Larger scale studies should be performed for validation.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.1-6
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• 2010

Purpose: Many surgical approaches for reconstruction of blow out fracture have been introduced, which include subciliary incision, transconjunctival incision and transcaruncular incision. Recently endoscopic approach has been attempted. This study was intended to show the effectiveness of the approach through transconjunctival incision combined with transnasal reduction in reconstructing blow out fracture to its original position. Methods: Medical recoreds of 43 patients from March 2008 to March 2009 who underwent surgery for orbital fracture were reviewed, retrospectively. All fractures were operated through transconjuctival incision approach combined with transnasal reduction. The average follow-up period was 10.1 months. To evaluate the surgical outcomes of orbital fracture, we performed CT of the facial bone before and after the surgery. In addition, preoperative and postoperative data of enophthalmos, diplopia and the limitation of extraocular motion was assessed with physical examination. Results: Post-operative CT scan of 43 patients assured that the bone fragments of the orbital fractures were restored to their original positions. Although a few patients developed postoperative transient diplopia or impairment of ocular movement, most of the patients recovered during the follow-up period without complication. Conclusion: From this study, we were able to demonstrate the effectiveness of the transnsasal reduction technique combined with the approach through transconjunctival incision. This technique can be considered as very useful means of repairing orbital fracture. It is not only easy to perform but also it can minimize the damage to the orbital bone. Furthermore, it can restore the fracture to its original position as much as possible.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.480-485
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• 2014

Background The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. Methods Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. Results Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. Conclusions Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.