Surgical Treatment of Medial Orbital Wall Fracture According to Proper Indication

Kim, Jun Pyo; Lee, Sun Woo; Kim, Jin; Lee, Hye Kyung

Abstract

Compared with orbital floor fracture, the frequency and significance of medial orbital wall fracture has been relatively ignored because of the lack of proper diagnosis and the difficulty of surgical approach. The surgical delay results to the troublesome complications like enophthalomos, extraocular muscle movement dysfunction. For the reason, it is necessary to measure the exact fracture part and bone defect size with CT scan, the ophthalmologic evaluation and the proper treatment for the indication. We operated on 17 medial orbital wall fracture patients with transnasal endoscopic approach, open reduction through minimal medial canthus incision(6-7 mm), or both methods according to the fracture type. We classified them into three types according to the degree of periosteal injury, the size of the bone defect and the degree of comminution with CT scanning and ophthalmologic evalution. In the case of Type 1, there is no herniation of orbital contents and periosteum is intact despite fracture. The patients of Type 1 can be treated by packing with Foley catheter, Merocel(R) sponge, etc. after bone reduction with transnasal endoscope. In the case of Type 2, which has the herniation of orbital contents and bone defect of approximately 1 cm or less in diameter with periosteum injury, after the bone defect site can be confirmed with an endoscope, the medial wall can be reconstructed by Titanium Mesh, silastic sheet or autogenous bone graft through minimal medial canthus incision. In the case of Type 3, the bone defect is over 1 cm in diameter accompanying comminuted fracture. The fractured medial wall of type 3 can be reconstructed with bone graft through coronal incision or open sky incision. Minor complications occurred in 7 patients but all patients were successfully treated without patient's complaints during the follow-up period of 6-18 months. In addition, the scar by minimal medial canthus incision is imperceptible. The indicaions make the fracture reduction easy and accurate. Especially, it is proper to pediatric patients and young female patients because it corresponds to minimal invasive Technique.