Clin Exp Otorhinolaryngol.  2015 Sep;8(3):250-255. 10.3342/ceo.2015.8.3.250.

Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube

• Kim JY
• Choi G
• Kwon JH

• KMID: 2117520
• DOI: http://doi.org/10.3342/ceo.2015.8.3.250

Abstract

OBJECTIVES
The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach.
METHODS
A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained.
RESULTS
In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries.
CONCLUSION
During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.

Keyword

Orbital Fractures; Silastic Tube; Transantral Approachx

MeSH Terms

Diplopia
Enophthalmos
Humans
Maxillary Sinus
Orbit*
Orbital Fractures
Retrospective Studies
Silicones
Silicones

Figure

• 

  Fig. 1 Illustrations showing the repair of the orbital floor fracture. (A) Note that the fractured fragments of the orbital floor and orbital fat are returned to their original place before the insertion of implants. (B) A silastic sheet (1 mm; arrowhead) is placed under the orbital floor and a bent silicon tube (arrow) is inserted into the maxillary sinus under the silastic sheet via a transantral approach.

• 

  Fig. 2 Silastic sheet and tubes used in this technique. (A) Silastic sheet (1 mm in thickness) placed under the fractured orbital floor in the maxillary sinus through the antral window. (B) Silicon tubes (0.5 mm for children, 1 mm for adults) for upholding the fractured orbital floor. (C) Various strategies for bending the silicon tubes.

• 

  Fig. 3 Intraoperative endoscopic views of the left maxillary sinus of an orbital floor fracture, through the antral window. (A) The orbital floor was fractured, and periorbital soft tissue was herniated into the maxillary sinus (arrow). (B) The fractured orbital contents were reduced to anatomic position and a silastic sheet was placed under the fractured bone. (C) Bent silastic tubing was inserted into the maxillary sinus to support the reduced orbital floor. (D) The silastic tube and sheet were removed, and the fractured orbital floor was well reduced (arrow, natural ostium).

• 

  Fig. 4 Coronal computed tomography (CT) scans of the blowout fracture of the inferior orbital wall. (A) Preoperative view. (B) Postoperative CT scan before silicone tube removal, the inferior orbital wall was supported with the silastic sheet and silicon tube. (C) Well reduced state of fractured bony wall after removal of silicon tube, two years postsurgery.

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