Reconstruction of the Orbital Floor Fracture using the Antral Balloon Catheter with Radiopaque Dye

PURPOSE: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. METHODS: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. RESULTS: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. CONCLUSION: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

The Endoscopic Treatment of Blow-out Fracture

Blow-out fracture is frequently encountered in facial bone trauma. It used to be reduced through sucilliary or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. Recently, endoscopic reduction of orbital wall was provided good functional and cosmetic results. In order to address this shortcoming we have explored the use of endoscopic transantral approach in orbital floor dissection to allow direct visualization of orbital content and whole fracture components. We performed endoscopic transantral approach with or without subcilliary incision in 10 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. The operative field in maxillary sinus was kept visually clear by saline irrigation and fine suction. For the maintain of the position of fractured site, urinary balloon foley catheter were used in fracture site for 2 weeks. There was no specific complications related to this procedure. Result of surgery in all cases were satisfactory. We discussed the surgical procedure, the advantages of the transantral endoscopic approach.

Simultaneous Transconjunctival and Transantral Approach for Repair of Blowout Fracture by using Medpor Orbital Implant

Surgical approaches to blowout fracture have been made through a skin inci-sion in the lower eyelid placed just below the eyelashes[a subciliary pproach], a conjunctival approach, a transantral approach, or a combined approach. Authors repaired the orbital floor fracture through the transconjunctival and transantral approaches simultaneously in 4 patients confirmed orbital floor fracture on CT scan from April to September 1998. Transconjunctival approach could avoid ectropion, lower eyelid retraction and transantral endoscopic orbital floor exploration could allow precise determination of fracture size, location, and replacement of prolapsed tissue and placement of implant over the bony defect. So it was possible to repair with a minimal size of implant and could avoid the complications caused by a too large implant in the posteriorly located orbital floor fracture.

Two-Wall Orbital Decompression for Endocrine Exophthalmos

We reviewed 17 cases with dysthyroid exophthalmos in 13 patients which were treated with antral-ethmoidal decompression surgery. Transantral approaches were done in 6 orbits of 3 patients and transfornix approaches were done in 11 orbits of 10 patients. The amount of postoperative retroplacement of the globe was 4.3mm in average and ranged from 1mm to 9mm during the average follow-up period of 14.9 months. All patients with compressive optic neuropathy improved in visual acuity by 3 or 4 lines of Hahn test chart. In most patients the restriction of ocular motility was improved and exposure keratitis decreased The cosmetic results were also satisfactory. The postoperative complications were induced diplopia in 2 cases and permanent infraorbital anesthesia in 1 case. The detailed surgical procedures and results were presented and reviewed.