Treatment of the Medial Blow-out Fracture by Medial Transconjunctival Approach

Blow-out fractures usually occur at the weakest point of orbital wall such as medial wall or orbital floor. The operative treatment of blow-out fracture involve restoration of intra-orbital soft tissue and bony structural integrity. The surgical reduction of medial blow-out fracture are mainly transcutaneous, transnasal and transconjunctival approaches. The conventional methods has several disadvantages, such as external scar, narrow operative field and injury of neurovascular bundle. But medial transconjunctival approach has advantages such as minimal scar, short operative time and relative safety. We experinced 26 cases of medial blow-out fracture using medial transconjunctival approach from June 2001 to May 2003. Preoperatively 21 cases showed diplopia and 14 cases showed enophthalmos. In postoperative complications, diplopia were 2 cases, enophthalmos was 1 case, anterior displacement of implant were 2 cases, conjunctival scar were 2 cases and injury of caruncle was 1 case. We report the medial transconjunctival approach that was effective treatment for medial blow-out fracture without specific complications.

Treatment of Medial Orbital Wall Fracture Using Medial Transconjunctival Approach

The term of blow-out fracture refers to a fracture of an orbital wall, typically the orbital floor or medial wall. Especially the medial blow-out fracture is difficulty to approach. Transcutaneous approaches could remain postoperative scars and transconjunctival approaches could give bad visual field and technically difficulties in approaching the medial orbital wall. But the medial transconjunctival incision could avoid an external scar, save the operating time, and decrease injuries of surrounding tissue. Authors operated the medial blow-out fractures through the medial transconjunctival approach and porous high-density polyethylene sheet was placed on fracture site for the prevention of relapse of the orbital contents. 30 cases of medial blow-out fractures were treated using the medial transconjunctival incision. All patients were corrected satisfactorily without leaving any visible scar. Thus the medial transconjunctival approach was an effective way to repair medial blow-out fracture.