Blowout Fractures: Endoscope-assisted Surgery for Accurate Visualization of the Posterior end of the Fracture

Abstract

 In surgery for blowout fractures, we place importance on dissection of orbital tissue adhesion with careful observation of the posterior end of the fracture before reduction. The deeper the posterior end of the fracture, the narrower the tissue space between the posterior end and extraocular muscles, and the extraocular muscles may contact the edge of the fracture, which further limits eye movements. However, when the posterior end of the fracture is deep, direct observation is difficult using the transorbital approach. In our department, endoscope is used to directly observe the posterior end of the fracture. We report an outline of this endoscope-assisted surgery.
 An endoscope is inserted into the middle nasal meatus as in routine endonasal surgery, and the orbital wall is observed via the maxillary sinus for orbital floor fractures and via the ethmoidal sinus for medial wall fractures.
 In non-fresh cases showing persistent diplopia, there is often adhesion between the posterior end of the fracture and ocular tissue, and visual confirmation is difficult using the transorbital approach. Endoscope-assisted surgery can overcome this disadvantage, facilitating accurate confirmation of the posterior end of the fracture.