TRANSCONJUNCTIVAL APPROACH IN RECONSTRUCTION OF MEDIAL ORBITAL WALL FRACTURES – A CASE REPORT
Abstract
Background. Isolated medial orbital wall fractures are rare, albeit untoward injuries. They can cause development of horizontal diplopia, enophthalmos and retraction of the globe upon abduction.
Conclusions. In correction of medial orbital wall fractures, one has to reduce the herniated orbital fat and cover the bony defect with a transplant – either an osseous autotransplant or an alternative allotransplant.
The medial canthus, i.e. medial palpebral ligament, which should not be desinserted, makes the surgical approach to the medial orbital wall more complicated. The classical approach is by a bicoronal incision, which can cause substantial blood loss. Exposure of the inferior part of the fracture often requires an additional inferior palpebral subcilliary approach.
The transconjunctival approach through the medial palpebral angle achieves thorough exposure of the entire fracture, the incision is small and blood loss negligible. The medial canthus represents no obstacle with this approach, as we stay dorsal to it throughout the procedure. Moreover, there are no skin incisions or scars with this procedure.
The first patient, successfully operated at our institution, is presented in this article.
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References
Chen CT, Chen YR, Tung TC, Lai JP, Rohrich RJ. Endoscopically assisted reconstruction of orbital medial wall fractures. Plast Reconst Surg 1999; 103: 714–21.
De Visscher JGAM, van der Wal KGH. Medial orbital wall fracture with enophthalmos. J Craniomaxillofac Surg 1988; 16: 55–9.
Rauch SD. Medial orbital blow-out fracture with entrapment. Arch Otolaryngol 1985; 111: 53–5.
Thering HR, Bogart JN. Blowout fracture of the medial orbital wall with entrapment of the medial rectus muscle. Plast Reconst Surg 1979; 63: 848– 52.
Longaker MT, Kawamoto HK Jr. Evolving thoughts on correcting posttraumatic enophthalmos. Plast Reconst Surg 1998; 101: 899–906.
Leone CR Jr, Lloyd WC III, Rylander G. Surgical repair of medial wall fractures. Am J Ophthalmol 1984; 97: 349–56.
Converse JM, Firmin F, Wood-Smith D, Friedland JA. The conjunctival approach in orbital fractures. Plast Reconst Surg 1973; 52: 656–7.
Zide BM, McCarthy JG. The medial cantus revisited – ananatomical basis for canthopexy. Ann Plast Surg; 11: 1–9.
Rubin PAD, Bilyk JR, Shore JW. Orbital reconstruction using porous polyethylene sheets. Ophthalmology 1994; 101: 1697–708.
Ortiz Monasterio F, Rodriguez A, Benavides A. A simple method for correction of enophthalmos. Clin Plast Surg 1987; 14: 169–75.
Rowe NL, Williams JLl. Fractures of the zygomatic complex and orbit. In: Williams JLl ed. Rowe and Williams’ maxillofacial injuries. London: Churchill Livingstone, 1994: 475–590. Medpor®- dodatne informacije na internetu: http://www.porexsurgical.com
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