Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

Woo Sub Shim; Hahn Jin Jung

doi:10.18787/jr.2019.26.2.65

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Shim and Jung: Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

Review

Journal of Rhinology 2019; 26(2): 65-74.

Published online: 30 November 2019

DOI: https://doi.org/10.18787/jr.2019.26.2.65

Management of Orbital Blowout Fractures: ENT Surgeon's Perspective

Woo Sub Shim, MD, Hahn Jin Jung, MD

Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea.

Corresponding author (hahnjin2@naver.com)

Received 21 September 2018 Revised 6 November 2018 Accepted 20 November 2018

Journal of Rhinology

Abstract

Orbital blowout fracture is a common result of facial trauma and is observed more frequently now than in the past as a result of introduction of computed tomography and increased incidence of high-energy impact injuries. Because orbital fracture may be associated with prolapse of the orbital contents into the paranasal sinuses, which results in sequelae such as diplopia and enophthalmos, proper diagnosis and timing of repair are crucial. However, clinical decision-making in the management of patients with orbital blowout fractures is challenging, and various aspects of orbital fracture management are uncertain. Numerous approaches have been used for reduction of blowout fracture. Controversies exist regarding indications for surgery, timing of surgery, and optimal reconstruction material. Recently, with expanding use of and indications for endoscopy in orbital blowout fracture surgery, otolaryngologists participate more often in facial trauma surgery, including blowout fracture. In this review, several controversial issues of surgical indication, surgical timing, method of approach, and choice of reconstruction material are discussed from the perspective of otolaryngology surgeons.

Keywords: Trauma, Orbital fracture, Orbital blowout fracture, Enophthalmos, Diplopia

Figures and Tables

Fig. 1

Facial bone CT scan images of medial blowout fracture. A: Preoperative images. B: Postoperative images (arrow: glove with Merocel®).

Fig. 2

Transconjunctival approach for inferior blowout fracture. A: conjunctival incision using Colorado needle tip, along the inferior border of the tarsal plate from not extending medially to the punctum with two traction sutures. B: dissection toward the orbital rim, between the orbital septum and orbicularis oculi muscle. C: periosteal incision at the inferior orbital rim. D: subperiosteal dissection and reduction of herniated orbital tissue. E: implant design (Medpore®). F: insertion of the implant, at least 3 sides of the implant should be laid over the fracture margin.

Fig. 3

Facial bone CT scan images of inferior blowout fracture. A: Preoperative images. B: Postoperative images (arrow: reconstruction material, Medpore®).

Table 1

Clinical recommendations for repair of isolated orbital floor fractures (adapted from reference #19)

CT: computed tomography

Table 2

Advantages and Disadvantages of the most common implants used for orbital reconstruction (adapted from reference #48)

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