Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures

Ah Reum Jeong; Sung Mo Kang

doi:10.3341/jkos.2015.56.8.1154

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

Original Article

J Korean Ophthalmol Soc 2015;56(8):1154-1159.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1154

Endoscopic Transnasal versus Transcaruncular Reconstruction in Isolated Medial Orbital Wall Fractures

Ah Reum Jeong, M.D., Sung Mo Kang, M.D.

Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea

Address reprint requests to Sung Mo Kang, MD Department of Ophthalmology, Inha University Hospital, #27 Inhang-ro, Jung-gu, Incheon 400-711, Korea Tel: 82-32-890-2400, Fax: 82-32-890-2417 E-mail: ksm0724@inha.ac.kr

∗ This study was presented as a narration at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

Received 13 March 201514 May 2015 Accepted 6 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Endoscopic transnasal reconstruction, Medial orbital wall fracture, Transcaruncular reconstruction

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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