Endoscopically assisted transconjunctival approach in orbital medial wall fractures

Full exposure of the medial orbital wall for fracture repair poses difficulty with traditional approaches except coronal incision, especially in cases of wide fracture. The endoscopic-assisted approach with limited incision has been introduced. The authors used the endoscopically assisted transconjunctival approach in 21 cases: 15 isolated medial orbital wall fractures and 6 cases of concomitant floor fractures. Through the medial transconjunctival slit incision, repair of the fracture using calvarial bone graft was undertaken with the aid of an endoscope. All patients recovered without any eye symptoms including clinically notable enophthalmos, but one immediate revisional operation was needed because of a displaced bone graft. Otherwise, the desired position of the graft was confirmed via computed tomography. The endoscopically assisted transconjunctival approach to the orbital medial wall provides improved surgical exposure of the most posterior and superior aspects of the fracture site, enabling more accurate reduction of orbital soft tissue and placement of bone grafts.