Transoral Endoscopic Assisted ORIF of Orbital Rim Fractures

Abstract

Objectives:

1) Evaluate the feasibility of a purely transoral approach to infraorbital rim fractures using endoscopic assistance. 2) Analyze the patient outcomes of cosmesis and the success rate of reduction and fixation.

Methods:

A retrospective review was conducted in 16 midface facial fracture patients that presented to a level one trauma center in 2011-2012 involving orbital rim fractures that did not require orbital floor exploration. All patients had open reduction internal fixation (ORIF) of midface facial fractures (medial and lateral buttress, and orbital rim) through a transoral approach utilizing endoscopic assistance. The zygomatic-frontal (ZF) suture line fractures were repaired through a superior blepharoplasty incision. Orbital rim ORIF was accomplished with modified curved and ladder plates from stock midface vendor plating systems. The plates were fabricated to be positioned laterally on the orbital rim and then course inferiorly to the inferior orbital nerve (ION) and medially fixated to the medial buttress bridging the orbital rim fracture.

Results:

All patients had acceptable reduction and fixation of orbital rim fractures with cosmetically acceptable results. There was no plate extrusion or infection or worsening of ION parasthesias, with six patients having immediate post-operative improvement in their ION parathesia. No post-operative enophthalmos or diplopia was noted and no revision surgery was needed.

Conclusions:

A transoral endoscopic approach for carefully selected midface fractures involving the orbital rim is feasible with acceptable results. Future work is needed to develop a prefabricated plate that can be stocked in mid-face plating systems.