Repair of the orbital floor fractures: The endoscopic trans-maxillary approach as minimally invasive approach: A case-report

Introduction The endoscopy in orbital surgery provides, similar to other surgical fields, the option of combining an extended view of the surgical field with minimally invasive approaches; also allows an excellent functional and esthetic results. Trans-maxillary endoscopy of the orbital floor offers excellent visualization of the posterior bony shelf and confirms that the implant rests securely in place. Presentation of case The authors report a ten years-old male child, reported to the oral and maxillofacial surgery department, Ibn Rochd university hospital, Casablanca, Morocco. The child was diagnosed for left orbital floor fracture, complaining of orbital trauma due to road accident. The injury occurred at the left orbit level. There was no general story of any disease. Discussion In more than 40% of all the facial fractures parts of the orbital rim or/and the internal orbit are injured with a variety of fracture patterns. Accurate assessment is required in order to correct any bone defects or displacements. The surgical approaches have become more reduced offering better control of orbital pathological processes. Orbital lesions are precisely localized through imaging. Also, the approach decision depends on location, size and vascularization. No consensus exists regarding the timing of the repair, the repair technique and the optimal implant. In this case presentation, the defect on the orbital floor was extended by mobilization of the fragments. A combination of incisions was necessary due to the change in the dimensions of the defects intraoperatively and entrapment of orbital tissue by the placement of an implant. Conclusion The endoscopic approaches provide excellent visualization and safe from eyelid complications with no visible scar when secondary open fracture reduction is avoided. Also; the rate of postoperative complications are reduced: optic nerve injury, orbital apex injury.
Highlights • Trans-maxillary endoscopy of the orbital floor offers excellent visualization of the posterior bony shelf • The technique confirms that the implant rests securely in place. • The endoscopy in orbital surgery provides the option of combining an extended view of the surgical field with minimally invasive approaches.