Endoscopic repair of orbital floor fractures /certified fixed orthodontic courses by Indian dental academy

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ENDOSCOPIC REPAIR OF
ORBITAL FLOOR FRACTURES
www.indiandentalacademy.com

www.indiandentalacademy.com
INDIAN DENTAL
ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

CONTENTS
 INTRODUCTION
 ORBITAL FLOOR FRACTURES
 TREATMENT MODALITIES
 ENDOSCOPE&PARTS
 HISTORY
 INDICATIONS
 ADVANTAGES
 DISADVANTAGES
 CONCLUSION
 REFERENCES
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INTRODUCTION
 ORBITAL FLOOR FRACTURES PRESENT
WITH SIGNIFICANT PROBLEMSWHICH
REQUIRE PROPER ATTENTIONAND
MANAGEMENT.
 THEREAREVARIOUS MODES OF
MANAGEMENTWITHTHEIR OWN
ADVANTAGESAND LIMITATIONS
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CLINICAL FEATURES
 EYELID EDEMA
 CIRCUMORBITAL ECCHYMOSIS
 SUBCONJUNCTIVAL
HEMORRHAGE
 ALTERATION OFVISUAL AXIS
 PARESTHESIA
 DIPLOPIA
 ENOPTHALMOS
 RESTRICTION OF OCULAR
MOVEMENT
 EPISTAXIS
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TREATMENT
 MEDICALTHERAPY
 SURGERY
1) conventional surgery
2) endoscopy
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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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DISADVANTAGES OF
CONVENTIONAL SURGERY:
 Post operative lid malposition
 Lid shortening
 Entropion
 Ectropion
 Limited visibility of posterior orbit
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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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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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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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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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$INDICATIONS:  Patients with 1)Trap door fracture 2) Medial blow out fractures 3) Lateral blow out fractures NOTE: Fractures extending lateral to infraorbital nerve or involving lamina papyracea are difficult to repair endoscopically. www.indiandentalacademy.com$

ENDOSCOPIC APPROACHES
 TRANS NASAL
 TRANSANTRAL
 INTRA ORAL
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$ADVANTAGES:  Improved visualisation  Anatomic fracture repair  No risk of post operative eyelid complications  Good clinical results  Increased illumination  Video projection for rest of the surgical team&documentation  Precise and complete reduction of herniated soft tissues  Correct implant placement www.indiandentalacademy.com$

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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COMPLICATIONS:
 INFRAORBITAL PARESTHESIA
 POST OPERATIVE SINUSITIS
 PERSISTENT DIPLOPIA
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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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$REFERENCES  Br.journalof plastic surgery ;jan 57(1)57(1)37 (1)37 -44  Endoscopic orbital floor repair J. of craniofacial surgery.2008 jan  Clinical recommendations for repair of isolated orbital floor fracture,M.Burnstine.opthalmology2002 vol109,(7),1207-1210  Lester Mc,blow out fractures of orbit ;br.j.plastic surgery,1965(18);171  Otolaryngol Clin North Am. 2007 Apr;40(2):319- 28 www.indiandentalacademy.com$

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