Retroseptal Transconjunctival Approach for Blowout Fracture of the Orbital Floor

 An Ideal Choice in East-Asian Patients:

Objective: To ask experts in the field to evaluate a surgeon’s experience with a retroseptal transconjunctival approach for the repair of the orbital floor damaged by blowout fracture that the surgeon encountered in 12 East-Asian patients.

Methods: Patients were identified from a database, and a retrospective case note review was conducted. A total of 12 conjunctival procedures were conducted for the repair of blowout fracture with no other complicating fractures. All operative procedures were done by transconjunctival approach alone without lateral canthotomy or any other additional approach.

Results: The repair of the orbital floor was successful in all the cases. Three patients had bone grafting to the orbital floor after reduction. The mean of overall surgical time was 48.8 minutes (range, 22–85 minutes) for orbit exposure by transconjunctival approach plus reduction and bone grafting when applicable. There were 6 urgent surgeries associated with missing or entrapment of the inferior rectus muscle, and its repair took an average of 32.0 minutes (range, 22–41 minutes). Postoperative diplopia recovered at an average of 12.4 weeks (range, 0–60 weeks); in urgent cases, it took an average of 5.3 weeks (range, 0–14 weeks) before recovery.

Conclusions: A retroseptal transconjunctival approach in repairing the orbital floor is a simple, easily manageable, and effective procedure, leaving no conspicuous facial scars. It has proved to be an optimal choice in blowout fracture cases, especially when there was urgency to decompress the ischemic inferior rectus muscle in as short a surgery time as possible.




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