Medial and inferior orbital wall fractures: purely endoscopic endonasal repair with polyethylene implants

INTRODUCTION: Medial and infero-medial orbital wall fractures (OWF) are extremely common. Although classic transfacial approaches still retain their value today, several transnasal endoscopic approaches have been already proposed. Given the superior stability given by non resorbable implants and the chances provided by modern biocompatibile materials, we introduced a new purely endoscopic technique employing a porous polyethylene implant. MATERIAL AND METHODS: 7 patients with medial OWF and 3 patients with inferomedial OWF underwent purely endoscopic treatment with porous polyethylene implant. The procedure requires an endoscopic anteroposterior ethmoidectomy and, in case of infero-medial wall fracture, middle antrostomy to grant access to the fracture side. Fractured bones are removed and orbital content herniation in the sinonasal tract is reduced. According to the anatomy of the patient a Medpor sheet is cut and modeled in a convex shape roughly mimicking the desired periobital curvature, with extension towards the orbital floor whenever required. The medpor sheet is held in place by the residual solid bony structures of the lamina papyracea and nasal packs preventing bleeding and are kept in place until postoperative day 2. 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. DISCUSSION AND CONCLUSIONS: Despite needing further validation, our technique showed preliminary excellent results, coupling the stronger support granted by non resorbable materials and the minimal invasiveness of the endoscopic approach without need for long term nasal packing.