Anteroposterior Ethmoidectomy in the Endoscopic Reduction of Medial Orbital Wall Fractures: Does It Really Reduce Stability?

The surgical treatment of isolated medial orbital wall fractures is still a much-debated topic in the literature due to the choice of many surgical accesses. The main options are represented by transcutaneous versus endonasal endoscopic approaches. Our study aims to clarify the role of ethmoidectomy in the pure endoscopic endonasal reduction of medial orbital wall fractures, evaluating the immediate postoperative outcome and its long-term stability. A total of 31 patients affected by isolated medial orbital wall fracture, treated only by endoscopic approach, were included in the study and divided in two groups: (A) 14 patients treated by endoscopic reduction and anterior ethmoidectomy; (B) 17 patients treated by endoscopic reduction and anteroposterior ethmoidectomy. Perioperative and 6-month postoperative follow-up CT scans were performed. With the use of 3D medical software, we evaluated the comparison between the treated orbit and the mirrored contralateral orbit in the two groups, in order to observe the reduction of the fracture. Furthermore, to check the stability of reduction and to evaluate any medial orbital wall changes, we provided a comparison between the 3D CT scan orbital images of immediate postoperative CT and 6-month follow-up. Data obtained showed that the intraoperative surgical reduction was successful in all 31 cases, but it was better in Group B. Stability of the reduction at 6 months was observed in both groups without significant discrepancies. In our opinion, the endonasal endoscopic approach with ethmoidectomy represents a valid and useful technique by which to treat medial orbital wall fractures. The anatomical detail of the buttressing structures of the medial orbital wall, as the second portion of the middle turbinate, grants long-term stability of the surgical outcome.