Endoscopic Management of Inferior Orbital Wall Fractures with Medpore Grafts

Objective: To describe endoscopic management of orbital floor fractures through the maxillary sinus along with placement of medpore grafts to reconstruct the orbital floor defect. Study Design: Prospective study. Level of evidence: 2b Setting: University medical hospital. Subjects and Methods: From January 2008 to March 2011, 13 patients with orbital floor fracture (11 males, 2 females, age range from 17-45 years) were included in this study. Inclusion criteria were; isolated orbital floor fracture, orbital floor fracture associated with non displaced zygomatic maxillary complex fracture, entrapment of inferior rectus muscle, diplopia, and with orbital floor defect size more than 1.5cm. Exclusion criteria included orbital floor fracture associated with displaced zygomatic maxillary complex fracture, inferior orbital rim fracture, and orbital floor defect size less than 1.5cm. endoscopic repair of the orbital floor fractures was done endoscopically through maxillary sinus. Outcome assessment was done clinically and with preoperative and postoperative CT scan. Results: The follow-up period ranged from 8-30 months. Cause of injury was motor cycle accident (MCA) in 6 patients, motor vehicle accident (MVA) in 3 patients, personal assault in 2 patients, and fall down in 2 patients. Endoscopic repair of the orbital floor fracture was successfully done for all patients without need for conversion to an external approach. Med pore (1.5mm) grafts were used for all the patients to graft orbital floor defect. Conclusion: Endoscopic repair of orbital floor fracture is an excellent and highly successful and safe alternative to the traditional external eye lid approach. It enables early surgical intervention without lid complications and safe assessment and identification of the fracture site with easy graft placement.