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Use or Misuse of a New Approach?

D. Gregory Farwell, MD; Bryan S. Sires, MD, PhD; J. David Kriet, MD; Robert B. Stanley Jr, MD, DDS

Arch Facial Plast Surg. 2007;9(6):427-433.

Objective  To evaluate the successes and challenges of endoscopic orbital floor fracture repairs.

Methods  We analyzed 53 orbital floor repairs and recorded the indications for surgery, factors that complicated the endoscopic repair or necessitated conversion to an open approach, and outcomes for each.

Results  Forty-five procedures were completed endoscopically. Repairs of smaller injuries confined entirely to the medial floor were readily accomplished, particularly when entrapment was the primary indication for surgery. Endoscopic repair became very difficult and often not possible when a large amount of soft tissue was herniated through the floor defect and when dissection medially onto the lamina papyracea and lateral to the infraorbital nerve was required for implant placement. Duration of follow-up was short for some patients, but no adverse trends in outcomes were identified.

Conclusions  Blowout fractures can be approached endoscopically. However, the technical challenge of working from below with a telescope tends to increase the difficulty of many repairs without improving results. Most blowout fractures are probably still best treated through an open approach, assuming that the lower eyelid incision is correctly performed.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento (Dr Farwell); Allure Facial Laser and Medispa, Kirkland, Washington (Dr Sires); Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City (Dr Kriet); and Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle (Dr Stanley).

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