Large Medial Orbital Wall Fracture in the Setting of Prior Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is performed as a treatment for refractory sinusitis. Ethmoidectomy is a component of FESS. In performing ethmoidectomy, the septa that are believed to buttress the medial orbital wall are removed. The impact of endoscopic sinus surgery upon orbital biomechanics have been studied in a cadaver model. These studies have demonstrated increased likelihood of medial orbital wall fracture in a cadaver model. In this report, the authors present the case of a patient who sustained facial trauma with a history of prior FESS. She developed a large medial orbital wall fracture and nondisplaced floor fracture. Reconstruction was successfully performed with an alloplastic implant. Despite increasing numbers of FESS operations performed, there is limited evidence in the literature regarding orbital fracture in patients with a history of FESS. This case provides support for the findings of the recent cadaver studies.