ナビゲーションシステムを併用した内視鏡補助下経結膜アプローチによる眼窩内側壁骨折整復固定術

抄録

　　For surgical treatment of medial wall orbital fractures, numerous approaches are selected such as subciliary, medial canthal, transconjunctival, transcaruncular, or transnasal approaches. Our choice of surgical approach for the treatment of medial wall orbital fractures is transconjunctival with the transcaruncular endoscopic approach assisted by simultaneous image-guided surgery. In this study, postoperative outcomes of patients who were treated by our method were compared with those who were treated by the conventional transnasal endoscopic approach.
　　Ten patients with medial wall orbital fractures who underwent surgery at our hospital between April 2009 and March 2017 were included in this study. Five patients were treated by our method (transconjunctival group) and the other five patients were treated by the transnasal endoscopic approach (transnasal group) . Postoperative ocular function and the orbital volume were compared between the two groups. The orbital volume was evaluated using the orbital volume ratio.
　　There were no significant differences in postoperative ocular movement between the two groups. The postoperative orbital volume ratio in the transconjunctival group significantly improved compared with that in the transnasal group (101.0% VS. 107.8%；p<0.05) . There were no postoperative complications related to our surgical approach.
　　By inserting the endoscope through a small conjunctival incision, the operator and other medical staff can share a wide and detailed surgical view of orbital fractures. With the assistance of the image-guided surgery, reduction and fixation of orbital fractures, especially around the orbital apex, were safely performed. Our method enables safe and precise reduction and fixation in the treatment of medial orbital wall fractures.