ABSTRACT
PURPOSE: To determine the surgical intervention time, which is most likely to achieve a high success rate for blowout fracture repair without implants and the usefulness of treatment with an intramaxillary sinus balloon. METHODS: Two hundred patients with isolated fractures of the orbit were evaluated by the Hess screen test, the Hertel exophthalmometer, and coronal computed tomography of the orbit. Operative criteria included diplopia within 30 degrees and enophthalmos >3 mm. An inferior lid incision approach was used to expose the orbital floor for realignment of bone fragments. Eighty of the patients received a gingival incision, followed by an osteotomy to create a 10-mm opening into the maxillary sinus for placement of a silicon-Teflon-silicon balloon. RESULTS: The highest success rate, with diplopia completely improved in 66% of the patients, was observed when surgery was performed within 3 days after the injury. This success rate declined as surgical intervention was delayed. In 197 cases, enophthalmos was improved to <2 mm postoperatively for patients who had surgery within 14 days. The balloon treatment was well tolerated and caused no complications. CONCLUSIONS: Surgery within 3 days is recommended in cases with diplopia and enophthalmos. An intramaxillary sinus balloon treatment was useful for the cases with large orbital floor fracture that could cause latent enophthalmos.
