Classification and Postoperative Results of Pure Medial and Inferior Blow-out Fractures.

Nam, Su Bong; Lee, Jae Woo; Kim, Kyoung Hoon; Choi, Soo Jong; Kang, Cheol Uk; Bae, Yong Chan

Original Article

Journal of Korean Cleft Palate-Craniofacial Association 2009;10(1):1-6.

Su Bong Nam, Jae Woo Lee, Kyoung Hoon Kim, Soo Jong Choi, Cheol Uk Kang, Yong Chan Bae

Department of Plastic and Reconstructive Surgery, School of Medicine, Pusan National University, Busan, Korea. csjsharks@empal.com

Abstract

PURPOSE
This study presents a classification of pure medial and inferior blow-out fracture, and confirms the relationship between the types of fractures, postoperative complications and operative methods. METHODS: Sixty patients were treated by transnasal endoscopic reduction with Medpor(R) implantation through subciliary incision and foley catheter insertion into maxillary sinus was done if there was extensive orbital floor fracture. Fractures were classified by number of coronal sections from posterior margin of fossa for lacrimal sac to orbital apex in CT. Type I is defined when the medial wall fracture is over 50% and inferior wall fracture below 50%. Type II, when below 50% medial wall fracture and over 50% floor fracture were present. If there were both over 50%, it was classified as Type III and both below 50% for Type IV. Extreme fracture involving orbital buttress was Type V and postoperative findings in all patients were examined.
RESULTS
Type I and V were most common and preoperative findings were more likely to present according to extent of inferior fracture. Diplopia remained in 2 cases after additional insertion of foley catheter, but enophthalmos over 2 mm were presented in 3 cases and diplopia in 3 cases were observed who were not treated with foley catheter.
CONCLUSION
Postoperative complications were increased according to extent of fracture, especially buttress involvement. Additional insertion of foley catheter proved its effectiveness in decreasing postoperative complications.

Keywords: Blow-out fracture; Endoscopy