Endoscopic endonasal-transantral surgery for an isolated orbital floor blow-out fracture in a pediatric patient

Year 2007, Volume: 17 Issue: 3, 179 - 182, 23.05.2007

Erdinç Aydın Babür Akkuzu Güzin Akkuzu Osman Nuri Özgirgin Levent Naci Özlüoğlu

Abstract

Orbital floor blow-out fractures occur due to blunt trauma causing displacement of orbital contents to the maxillary sinüs while the orbital rim is intact. Surgical repair of these fractures includes transantral, transor- bital, or endoscopic endonasal approaches with or without implant use. We report a 12-year-old boy who presented with diplopia after blunt trauma to the head while playing football. Computed tomography revealed a left isolated orbital blow-out fracture. The patient was treated by a combined endoscopic endonasal- transantral approach and stability was restored with a urethral balloon catheter following endoscopic reduc- tion of the fracture. Healing of the orbital floor was con- firmed by an early computed tomography scan. This technique restores eye volüme and function without the use of external incisions or implants.

Keywords

Balloon dilatation, child, endoscopy, fracture fixation/methods, orbital fractures/surgery

Bir çocuk hastada izole orbita taban› blow-out kırığının endoskopik endonazal-transantral cerrahi ile tedavisi

Abstract

Orbita tabanı blow-out kırıkları, künt travma sonrası orbital rimin salim kalıp, orbita içeriğinin maksiller si- nus içine yer değiştirmesi sonucu oluşur. Bu kırıkla- rın cerrahi tedavisi transantral, transorbital veya en- doskopik endonazal yaklaşımlarla, implant kullana- rak veya kullanmadan yapılabilir. On iki yaşında er- kek hasta, futbol maçı sırasında başta künt travma sonucu oluşan diplopi nedeniyle başvurdu. Bilgisa- yarlı tomografide sol blow-out kırığı saptandı. Kom- bine endoskopik endonazal-transantral yolla tamir yapılan hastada üretral balon kateter ile destek sağ- landı. Hastanın erken tomografik kontrolünde orbita tabanının iyileştiği görüldü. Bu yöntem, temel amaç olan göz hacmi ve fonksiyonunun korunmasını, hari- ci kesiler ve implantlar kullanılmadan sağlayan bir tekniktir

Keywords

Balon dilatasyonu, çocuk, endoskopi, kırık tespiti/yöntem, orbital kırık/cerrahi

References

• Smith B, Regan WF Jr. Blow-out fracture of the orbit; mechanism and correction of internal orbital fracture. Am J Ophthalmol 1957;44:733-9.
• Converse JM, Smith B, Obear MF, Wood-Smith D. Orbital blowout fractures: a ten-year survey. Plast Reconstr Surg 1967;39:20-36.
• Manson PN, Iliff N. Management of blow-out fractures of the orbital floor. II. Early repair for selected injuries. Surv Ophthalmol 1991;35:280-92.
• Gazarian PK. Action stat. Blow-out fracture. Nursing 2000;30:33.
• Courtney DJ, Thomas S, Whitfield PH. Isolated orbital blowout fractures: survey and review. Br J Oral Maxillofac Surg 2000;38:496-504.
• Aygıt AC, Demiralay A, Bayçın N. Orbita tabanı ‘blow-out’ kırıklarında kemik kayıplarının ‘poröz po- lietilen’ implant ile onarımı. Ulusal Travma Dergisi 1999;5:175-9.
• Bahr W, Bagambisa FB, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: a ret- rospective study. Plast Reconstr Surg 1992;90:585-91.
• Holtmann B, Wray RC, Little AG. A randomized com- parison of four incisions for orbital fractures. Plast Reconstr Surg 1981;67:731-7.
• Özdek Ş, Ünal M, İleri F, Hasanreisoğlu B. Orbita blow-out kırıklarında cerrahi tedavi yaklaşımları. Medical Network Oftalmoloji 1999;6:382-5.
• Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg 1998;14:379-90.
• Gatot A, Tovi F. Early treatment of orbital floor frac- tures with catheter balloon in children. Int J Pediatr Otorhinolaryngol 1991;21:97-101.
• Ikeda K, Suzuki H, Oshima T, Takasaka T. Endoscopic endonasal repair of orbital floor fracture. Arch Otolaryngol Head Neck Surg 1999;125:59-63.