Endoscopic endonasal approach for repairing an outwardly herniated blow-out fracture lateral to the infraorbital nerve
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Endoscopic endonasal approach for repairing an outwardly herniated blow‑out fracture lateral to the infraorbital nerve Shinya Takaishi1,2 · Jiro Iimura2 · Nobuyoshi Otori1 Received: 28 June 2020 / Accepted: 18 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background To repair a blow-out fracture, the endonasal approach is indicated when the center of the fracture occurs in the orbital floor medial to the infraorbital nerve, or when the orbital tissue is herniated inwards; additionally, the combined endonasal and transmaxillary approach is indicated for fractures of the anterior and lateral parts of the orbital floor. Method and conclusion The use of endoscopic modified medial maxillectomy and special instruments enabled the surgeon to repair an outwardly herniated blow-out fracture by the endonasal approach alone, despite the center of the fracture being in the orbital floor lateral to the infraorbital nerve. Keywords Blow-out fracture · Endoscopic modified medial maxillectomy · Infraorbital nerve
Relevant surgical anatomy concerning blow‑out fracture The optimal surgical method for an orbital floor fracture is selected based on the extent and region of the fracture. The endonasal approach is usually indicated when the center of the fracture occurs in the orbital floor medial to the infraorbital nerve, or when the orbital tissue is herniated inwards; additionally, the combined endoscopic endonasal and transmaxillary approach is often indicated for fractures of the anterior and lateral parts of the orbital floor. Here, we describe a procedure to repair an outwardly herniated blowout fracture by the endoscopic endonasal approach alone without the transmaxillary approach, despite the center of the fracture being in the orbital floor lateral to the infraorbital nerve.
Electronic supplementary material The online version of this article (doi:https://doi.org/10.1007/s00405-020-06232-z) contains supplementary material, which is available to authorized users. * Shinya Takaishi [email protected] 1
Department of Otorhinolaryngology, Jikei University School of Medicine, 3‑25‑8 Nishi‑shinbashi, Minato‑ku, Tokyo 105‑8461, Japan
Department of Otorhinolaryngology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
2
Description of the technique The authors have obtained the individual’s free prior informed consent to images, information, and video from the individual participant. Computed tomography (CT) revealed bony fracture of the right side of the orbital floor and herniated orbital tissue (Fig. 1a–d). The center of the fracture was beyond the infraorbital nerve on the orbital floor. First, we performed endoscopic modified medial maxillectomy. An incision was made in the mucosa of the lateral wall along the anterior margin of the inferior turbinate. After removal of the medial maxillary wall, this approach allowed direct access to the inside of the maxillary sinus with preservation of the nasolacrimal duct and the inferior turbinate. Prelacrima
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