Endoscopic Endonasal Repair of Medial Orbital Wall Fractures: A Systematic Review

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BACKGROUND: Techniques in endoscopic repair of orbital fractures have significantly improved over the last 20 years. This systematic review reports the surgical outcomes of endonasal endoscopic repair of isolated medial orbital fractures. METHODS: A systematic review utilizing PRISMA guidelines was performed. Two investigators independently screened and reviewed 625 studies, and studies exploring endonasal endoscopic surgical repair of isolated medial orbital fractures were considered for inclusion. Primary outcomes included improvement and/or resolution of diplopia, enophthalmos, and extraocular muscle restriction. Secondary outcomes included complications, implant extrusion, and revision surgery. RESULTS: Six studies were included with a total of 204 patients with isolated medial orbital wall fractures. 73.5% (150) of patients were male, with a mean age 40.5 years (range 13-74 y). Primary outcomes for patients undergoing endoscopic endonasal repair of isolated medial fractures, including diplopia, enophthalmos, and extraocular muscle restriction, improved or resolved in 98.1%, 88.2%, and 100% of patients, respectively. No complications of blindness, recurrence, or revision surgery were reported. CONCLUSIONS: Endoscopic management of medial orbital wall fractures has been demonstrated to be both safe and highly effective in resolving symptoms of diplopia, enophthalmos, and extraocular muscle restriction.

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