Journal List > J Korean Ophthalmol Soc > v.56(8) > 1010042

Jeong and Kang: Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures

Abstract

Purpose

To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in iso-lated medial orbital wall fractures.

Methods

This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extra-ocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction.

Results

The 2 surgical methods showed no significant differences in primary gaze diplopia ( p = 0.50), restriction of EOM move-ments ( p = 0.48), remaining enophthalmos of more than 2 mm ( p = 0.99), and improvement in enophthalmos ( p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia ( p = 0.04) 6 months af-ter surgery.

Conclusions

The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.

References

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Table 1.
Demographics of the 79 surgical patients
Endoscopic (n = 35) Transcaruncular (n = 44) p-value
Mean age (years) 38.4 ± 13.8 35.7 ± 13.7 0.40
Sex (n, %)
 Male 26 (74.3) 27 (61.4) 0.22
 Female 9 (25.7) 17 (38.6) 0.22
Orbital implant (n, %)
 Non-absorbable, Medpor® 3 (8.6) 9 (20.5) 0.14
 Absorbable, MacroSorb® 32 (91.4) 35 (79.5) 0.14

Values are presented as mean ± SD unless otherwise indicated. Independent samples t-test was used to examine statistical difference. Endoscopic = endoscopic endonasal reduction; Transcaruncular = transcaruncular reduction.

Table 2.
Incidence of diplopia before and 6 months after surgical repair
Diplopia at primary gaze Diplopia at peripheral gaze
Preop Postop Preop Postop
Endoscopic (n = 35) 3 (8.6%) 0 7 (20.0%) 5 (14.3%)
Transcaruncular (n = 44) 9 (20.5%) 2 (4.5%) 5 (11.4%) 15 (34.1%)
p-value 0.14 0.50 0.28 0.04

Chi-square test and Fisher’s exact test was used to examine statistical difference. Endoscopic = endoscopic endonasal reduction; Transcaruncular = transcaruncular reduction; Preop = preoperative; Postop = postoperative.

Table 3.
Incidence of EOM restriction, enophthalmos before and 6 months after surgical repair
EOM restriction ≥2 mm enophthalmos
Preop Postop Preop Postop
Endoscopic (n = 35) 8 (22.9%) 3 (8.6%) 6 (17.1%) 1 (2.9%)
Transcaruncular (n = 44) 15 (34.1%) 6 (13.6%) 5 (11.4%) 1 (2.3%)
p-value 0.28 0.48 0.46 0.99

Chi-square test and Fisher’s exact test was used to examine statistical difference.

EOM = extraocular muscle; Preop = preoperative; Postop = postoperative; Endoscopic = endoscopic endonasal reduction; Transcaruncular = transcaruncular reduction.

Table 4.
Enophthalmos measurements before and 6 months after surgical repair
Preop enophthalmos (mm) Postop enophthalmos (mm) Enophthalmos improvement (mm)
Endoscopic (n = 35) 0.90 ± 0.78 -0.19 ± 0.68 1.09 ± 0.88
Transcaruncular (n = 44) 0.70 ± 0.83 -0.03 ± 0.73 0.74 ± 0.77
p-value 0.29 0.35 0.07

Values are presented as mean ± SD unless otherwise indicated. Independent samples t-test was used to examine statistical difference. Preop = preoperative; Postop = postoperative; Endoscopic = endoscopic endonasal reduction; Transcaruncular = transcaruncular reduction.

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