Objective 1) Describe how to endonasally access the inferior orbital wall for the reduction surgery using endoscope. 2) Show the usefulness of the endoscopic endonasal approach for alternative to the current approaches. Methods Between 1997 and 2007, 41 patients with isolated inferior blowout fractures not involving the medial wall underwent surgery. The surgical treatment was determined due to persisting diplopia for 2 to 4 weeks after the trauma. In 38 of the 41 patients the reduction surgery was completed using only the endoscopic endonasal approach. To achieve the endoscopic endonasal reduction surgery, via the middle nasal meatus, septoplasty was supplemented in 7 patients and sub-mucous conchotomy in 36. In 16 patients the inferior antrostomy was additionally required to reach the fracture site. The bone fragments entrapping the orbital content were carefully removed. An ophthalmologist verified the ocular motility improvement by eye traction test. No permanent supporting material except temporary balloon fixation was used. Results No surgical complications were encountered in any of the patients. Postoperatively, diplopia disappeared in 32 of the 35 patients (91.4%) followed over 6 months. No patients complained of postoperative buccal paresthesia or enophthalmos. Conclusions An endoscopic endonasal reduction surgery for isolated blowout fractures has so far been considered as technically difficult. Our procedure to access the inferior orbital wall comprise sinonasal surgery techniques that have been conventionally used. We conclude that the endoscopic endonasal approach can be an alternative to the extranasal methods because of safety and usefulness.
Endoscopic Endonasal Approach of Orbital Medial Wall Reconstruction using Septal Cartilage: A Rare Surgical Case Report
