Combined transconjunctival and transcaruncular approach with multiple sheet implantation for three-dimensional reduction of concomitant medial and inferior orbital wall fracture.

Abstract

The aim of this retrospective study was to present the technique for three-dimensional reduction of concomitant medial and inferior orbital wall fracture by placing multiple thin bioabsorbable sheet implants and to evaluate the surgical outcomes. Twenty-six patients (14 males and 12 females) were included in this study. Surgery was performed through separate transconjunctival and transcaruncular incisions, and 2 or 3 pieces of thin bioabsorbable sheet implants of hydroxyapatite and poly L-lactide composite were inserted through each. In 11 cases with inferomedial orbital strut fracture, these implants were in contact with the inferomedial orbit. Surgical outcomes were evaluated using a 5-point scale based on the binocular single vision field (BSV), area of field of BSV, and orbital volume measured on computed tomography. Consequently, three-dimensional reconstruction was successfully achieved in all cases with no complications. Postoperatively, the field of BSV scale (p < 0.001) and area of field of BSV (p < 0.035) were significantly improved. There was no significant difference in orbital volume between the repaired and unrepaired sides (p = 0.807). Based on these findings, the approach presented here is an effective technique for repairing concomitant inferior and medial orbital wall fractures.