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1. ENDOSCOPIC REPAIR OF
ORBITAL FLOOR FRACTURES
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INDIAN DENTAL
ACADEMY
Leader in continuing dental education
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3. CONTENTS
 INTRODUCTION
 ORBITAL FLOOR FRACTURES
 TREATMENT MODALITIES
 ENDOSCOPE&PARTS
 HISTORY
 INDICATIONS
 ADVANTAGES
 DISADVANTAGES
 CONCLUSION
 REFERENCES
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4. INTRODUCTION
 ORBITAL FLOOR FRACTURES PRESENT
WITH SIGNIFICANT PROBLEMSWHICH
REQUIRE PROPER ATTENTIONAND
MANAGEMENT.
 THEREAREVARIOUS MODES OF
MANAGEMENTWITHTHEIR OWN
ADVANTAGESAND LIMITATIONS
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6. CLINICAL FEATURES
 EYELID EDEMA
 CIRCUMORBITAL ECCHYMOSIS
 SUBCONJUNCTIVAL
HEMORRHAGE
 ALTERATION OFVISUAL AXIS
 PARESTHESIA
 DIPLOPIA
 ENOPTHALMOS
 RESTRICTION OF OCULAR
MOVEMENT
 EPISTAXIS
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7. TREATMENT
 MEDICALTHERAPY
 SURGERY
1) conventional surgery
2) endoscopy
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8. Access to orbital
floor# :
 Lateral & medial eyebrow
 Crows feet , existing laceration
 Subciliary or blepheroplasty
 Infraorbital , medial canthal
 Transconjunctival, bicoronal
 Transnasal , antral , buccal sulcus
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10. DISADVANTAGES OF
CONVENTIONAL SURGERY:
 Post operative lid malposition
 Lid shortening
 Entropion
 Ectropion
 Limited visibility of posterior orbit
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11. NEED FOR ENDOSCOPE
 POORVISUALISATION OF POSTERIOR
EDGE OF FRACTURE INVOLVING
POSTERIOR PORTION OF FLOOR.
 INABILITYTO SEETHE CONDITION OFTHE
HERNIATEDTISSUE BEFORE REDUCTION
 HELPSTO CONFIRMTHATALLTHE SOFT
TISSUES HAVE BEEN ELEVATED FROMTHE
FRACTURE SITE.
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12. ENDOSCOPE:
 An instrument used to examine
the interior of a hollow organ
or cavity of the body.
 Unlike other medical imaging
devices endoscopes can be
directly inserted in to an organ.
 Can be used succesfully in
various fields of medicine both
as diagnostic tool or for
treatment.
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13. HISTORY
 Philip Bozzini in 1806 -developed first
endoscope.
 William beaumont in 1822-first introduced
endoscope in to human body.
 Karl storz in 1945-started producing
endoscopes to ENT surgeons.
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14. PARTS:
 A rigid or flexible tube
 A light delivery system to illuminate the
organ or object under inspection
 A lens system transmitting image to the
viewer from the fiberscope
 An additional channel to allow entry of
medical instruments or to manipulate
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15. INDICATIONS:
 Patients with
1)Trap door fracture
2) Medial blow out fractures
3) Lateral blow out fractures
NOTE: Fractures extending lateral to
infraorbital nerve or involving lamina
papyracea are difficult to repair
endoscopically.
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16. ENDOSCOPIC APPROACHES
 TRANS NASAL
 TRANSANTRAL
 INTRA ORAL
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20. ADVANTAGES:
 Improved visualisation
 Anatomic fracture repair
 No risk of post operative eyelid complications
 Good clinical results
 Increased illumination
 Video projection for rest of the surgical
team&documentation
 Precise and complete reduction of herniated soft tissues
 Correct implant placement
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21. DISADVANTAGES:
 PRESENCE OF ORBITAL FAT INTERFERES
WITH INTRAORBITAL USE OF ENDOSCOPE
 TECHNIQUE SENSITIVE
 TRAINED PERSONNEL REQUIRED
 NOT ECONOMICAL
 CAN BE USED IN SOME PARTICULARS
CASES ONLY.
 NEED OF SURGERY IN CASE OF FAILURE.
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22. COMPLICATIONS:
 INFRAORBITAL PARESTHESIA
 POST OPERATIVE SINUSITIS
 PERSISTENT DIPLOPIA
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23. CONCLUSION:
 THE REPAIR OF ORBITAL FLOOR FRACTURE
IS PEREFORMED SUCCESSFULLY USING
ENDOSCOPES IN MANY CENTERS.
 IT ISTECHNICALLY DEMANDINGAND
REQUIREAN EXPERTISE IN USING
ENDOSCOPE.
 IT APPEARSA PROMISING NEW
TECHNIQUE FOR ISOLATEDTRAP DOOR
AND MEDIAL FLOOR FRACTURES.
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24. REFERENCES
 Br.journalof plastic surgery ;jan 57(1)57(1)37 (1)37
-44
 Endoscopic orbital floor repair J. of craniofacial
surgery.2008 jan
 Clinical recommendations for repair of isolated
orbital floor
fracture,M.Burnstine.opthalmology2002
vol109,(7),1207-1210
 Lester Mc,blow out fractures of orbit ;br.j.plastic
surgery,1965(18);171
 Otolaryngol Clin North Am. 2007 Apr;40(2):319-
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