Broad Application of the Endoscope for Orbital Floor Reconstruction: Long-Term Follow-Up Results

BACKGROUND: Transantral endoscopic repair of orbital floor fracture minimizes the risk of implant misplacement and avoids complications associated with traditional lower eyelid approaches. Contrary to most publications, its application is not limited to early intervention of pure orbital blow-out fractures. The authors present their results of broad application of this technique, with longer-term patients' follow-up. METHODS: A retrospective review of 32 patients over a 10-year period (March of 1998 to June of 2008) was performed. The mean duration of follow-up was 27.5 months (range, 4 months to 10 years). Sixteen patients (50 percent) had associated zygoma, inferior orbital rim, and Le Fort I fractures. Twenty-five patients (78.1 percent) had enophthalmos, with 14 of these cases being 2 mm or more in severity. Diplopia was present in 15 patients (46.9 percent) preoperatively. Operations were performed within 2 weeks for 25 patients (78.1 percent). Twenty-eight patients required orbital floor reconstructions. Four of five patients with associated orbital medial wall fractures underwent simultaneous orbital medial wall reconstruction. RESULTS: All patients had successful reduction of orbital fractures. Two patients had residual enophthalmos of 1 mm postoperatively. Due to delay in surgery and the nature of injury, only 11 of the 15 patients with diplopia had complete resolution after surgery. One patient required drainage of recurrent sinusitis 1 year after surgery. CONCLUSIONS: In suitably selected patients with orbital floor fractures, the transantral endoscopic approach is safe and reliable. Delayed surgery or associated zygomaticomaxillary complex fractures are not contraindications for the use of this technique. Long-term follow-up showed maintenance of the surgical results.