Treatment of Blow-out Fracture Located in the Posterior Portion of the Orbital Floor

ABSTRACT

Until now, there has been many papers about orbital blow-out fracture, but reports regarding the treatment and the prognosis of fractures located in the posterior portion of the orbital floor have been limited. The most common fracture site of the orbital floor is the medial portion of the infraorbital groove and repairing of the floor fracture located in the anterior portion of the floor is relative easy and has minimal complications. But when the fracture is located in the posterior portion of the floor, the possibility of the optic nerve injury is anticipated by surgical manipulation itself and the implanted silastic sheet Authors reconstructed posterior portion of the orbital floor fracture through conjunctival approach combined with Caldwell-Luc procedure in 5 patients, confirmed posterior orbital floor fracture on CT scan from July 1993 to November 1994. The results were satisfactory with no residual diplopia. Complications including prolonged maxillary sinusitis and lateral canthal deformity were encountered in each patient, but cured with ENT treatment and lateral canthoplasty. In reconstruction of orbital floor fracture, Caldwell-Luc approach was seldom used because of several reasons including the poor predictability, bleeding problrm, and the high incidence of sinus infection. But recently, Caldwell-Luc approach is reanimated by some endoscopic surgeons because of good visualization and less traumatic. In case of posterior floor fracture, our surgical method can reduce the possibility of injury to optic nerve and vital tissues around the orbital apex in spite of enlarging surgical field.