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Kim and Kang: Endoscopic and Transconjunctival versus Transcaruncular and Transconjunctival Reconstruction of Medial and Inferior Orbital Wall Fractures
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(5): 579-585.

Published online: 15 May 2017

DOI: https://doi.org/10.3341/jkos.2017.58.5.579

Endoscopic and Transconjunctival versus Transcaruncular and Transconjunctival Reconstruction of Medial and Inferior Orbital Wall Fractures

Jung Yong Kim, MD, Sung Mo Kang, MD

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 22332, Korea. Tel: 82-32-890-2400, Fax: 82-32-890-2417, Ksm0724@inha.ac.kr

Received 22 December 2016       Revised 22 February 2017       Accepted 11 April 2017

©2017 The Korean Ophthalmological Society

(open-access):

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 two combined surgical techniques, endoscopic endonasal surgery with transconjunctival reconstruction and transcaruncular surgery with transconjunctival reconstruction, when used to treat both medial and inferior orbital wall fractures.

Methods

A retrospective review of 63 patients who were followed up from January 2011 to December 2014 at Inha University Hospital for surgical reconstruction of combined medial and inferior orbital wall fractures was undertaken. We compared between the patients the computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-6 months surgery. A total of 29 patients received endoscopic transnasal surgery with trasconjunctival reconstruction, and 34 received transcaruncular surgery with trans-conjunctival reconstruction.

Results

There were no significant differences between the two combined methods in terms of the primary and peripheral gaze diplopia or the restriction of EOM movement 6 months after surgery. However, statistically significant differences were observed in exophthalmometer measurements 6 months after surgery.

Conclusions

The two combined surgical methods showed similar results in terms of postoperative primary and peripheral gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic endosnasal surgery with transconjunctival reconstruction showed several advantages over the other method considered in this study. An appropriate surgical method should be selected by comparing the relative advantages and disadvantages.

Keywords: Combined medial, Inferior orbital wall fractures

Figures and Tables

Figure 1

Clinical photographs of preoperative combined medial and inferior orbital wall fracture. (A) In near face view. (B) Worm's eye view, photographs of postoperative combined medial and inferior orbital wall fracture with Endoscopic transnasal and transconjunctival approach. (C) In near face view. (D) Worm's eye view.

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Figure 2

Orbital Computed tomography of the patient. Orbital Computed tomography of preoperative combined medial and inferior orbital wall fracture. (A) Axial view. (B) Coronal view. Well-reconstructed medial and inferior orbital wall fracture with Endoscopic transnasal and transconjunctival approach. (C) Axial view. (D) Coronal view.

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Table 1

Demographics of the surgical patients

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Values are presented as mean ± SD unless otherwise indicated. Independent samples t-test was used to examine statistical difference.

Endoscopic with transconjunctival = endoscopic endonasal with transconjunctival reduction; Transcaruncular with transconjunctival = transcaruncular with transconjunctival reduction.

Table 2

Incidence of diplopia before and 6 months after repair

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Values are presented as n (%) unless otherwise indicated. Chi-Square test and Fisher's Exact test was used to examine statistical difference.

Endoscopic with transconjunctival = endoscopic endonasal with transconjunctival reduction; Transcaruncular with transconjunctival = transcaruncular with transconjunctival reduction; Pre op = preoperative; Postop = postoperative.

Table 3

Extraocular muscle restriction before and 6 months after surgical repair

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Values are presented as n (%) unless otherwise indicated. 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 4

Hertel's exophthalmometer measure before and 6 months after surgical repair

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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; Preop Exo = preoperative exophthalmometer measure; Postop 6 month Exo = postoperative 6 months exophthalmometer measure; Preop Exo diff = preoperative exophthalmometer measurement difference; Postop 6 month Exo diff = postoperative 6 months exophthalmometer measurement difference.

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