Vol.99 No.10 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 99 No. 10 October 2006
Endoscopic Surgery for Traumatic Outpatients
with Internal Orbital Fracture
Hiroshi Osafune, Tadayuki Yasoshima, Akira Seto,
Yukiko Seto, Kouji Matsushima, Mayumi Kobayashi,
Etsuko Shirasaka, Hirotaka Osafune and Hideo Edamatsu
(Omori Hospital, Toho University School of Medicine)
Objective: Minimally invasive treatment for medial wall fracture of the orbit can be adequately performed for traumatic outpatient under local anesthesia, even in children. Prompt recovery of damaged orbital movement and minimally invasive surgery are important for this kind of trauma.
Cases: Three outpatients were treated within a few days after trauma. They were a 12-year-old boy, and a 24 and a 50 year old man. They experienced strong orbital pain on looking medially rather than double vision, and needed apparently prompt repair.
Local anesthesia involved insertion of several pieces of small cotton gauze embedded with 4％ xylocaine and 0.5％ epinephrine. With 4 mm diameter endoscopic aided surgery, the fractured part of the nasal middle meatus could be seen clearly and was repaired with a surgical elevator. Pain and bleeding were well controlled and the operation time was less than thirty minutes, including anesthesia. Immediately after repair, they could feel no orbital pain and experienced no other problem.
Discussion and Conclusion: Traumatic fracture between the orbit and paranasal sinus requires prompt and adequate treatment for orbital movement and the cosmetic appearance. The fracture is classified into two lesions, the blowout fracture of the inferior floor of the orbit or the superior wall of the maxillary sinus (inferior type), and fracture of the medial wall of the orbit or anterior ethmoidal cell (medial type). Symptoms and treatments differ in these two types. Treatments also vary in the two types between rhinology, plastic surgery, and ophthalmology. Our strategy in cases requiring surgical treatment is a trans-maxillary-sinus approach for the inferior type under general anesthesia, and an endoscopic nasal approach with local anesthesia in the outpatient clinic for the medial type.
Endoscopic observation of the fracture and careful repair under sufficient local anesthesia are necessary for this treatment. The surgical results are very safe and satisfactory for both the patients and our medical staff.
Key words :endoscopic surgery, internal fracture of orbit, minimally invasive treatment