Purely endoscopic endonasal reconstruction of medial and inferior orbital wall fractures with polyethylene implants

AIMS: Medial and inferior orbital wall fractures (OWF) are extremely common. Although classic transfacial approaches still retain their value, several transnasal endoscopic approaches have been proposed over time. Reconstruction of the fractured wall has obvious advantages and modern biocompatibile materials overcome the disadvantage of autologous implants. We introduced a new purely endoscopic reconstruction technique of the medial orbital wall employing a porous polyethylene implant. METHODS: 3 patients with medial OWF and 2 patients with inferomedial OWF underwent purely endoscopic management. The procedure required an endoscopic anteroposterior ethmoidectomy and, in case of infero-medial wall fracture, middle antrostomy to grant access to the fractured site. Small pieces of fractured bone are removed and orbital content herniation in the sinonasal tract is reduced. According to the anatomy of the patient a Medpor (High density porous poliethilene) sheet is modeled in a convex shape roughly mimicking the desired periobital curvature. The Medpor sheet is held in place lying on the residual bony structures of the lamina papyracea. RESULTS: All patients showed complete enophthalmos reduction and no complications were reported. At the 1-week and 1-month control there were no signs of local infection. The results remained stable without any late complication 6 months after the procedure. One of the major advantages of this technique is the absence of pain and swelling in all patients. CONCLSION: Despite needing further validation, our technique showed excellent preliminary results, coupling the stronger support granted by non resorbable materials with the minimal invasiveness of the endoscopic approach.