Combined Transconjunctival and Transcaruncular Approach for Repair of Large Medial Orbital Wall Fractures

Objectives: To describe the combined transcaruncular and transconjunctival approach in isolated large medial orbital wall fractures and to study the implications of uncorrected posterior orbital volume on postoperative enophthalmos. Methods: A retrospective medical record review was performed of 23 consecutive patients who underwent reduction surgery for isolated large medial orbital wall fractures using the combined transcaruncular and transconjunctival approach between February 1, 2003, and October 31, 2007. The unaffected contralateral orbital volume was assumed to represent the pretrauma volume of the affected orbit, and the uncorrected posterior orbital volume after reduction was determined using a software program. Results: The mean (SD) volume of the affected orbit changed from 26.00 (2.01) cm(3) to 24.08 (2.06) cm(3) after reduction, which was still larger than the contralateral unaffected orbit by 1.48 (0.83) cm(3). Despite the uncorrected volume in the most posterior portion of the medial wall, the mean (SD) postoperative enophthalmos measured only 0.17 (0.29) mm using Hertel exophthalmometry at a mean follow-up of 8.5 months. Conclusions: The combined transconjunctival and transcaruncular approach results in excellent outcomes in terms of prevention of postoperative enophthalmos of the large medial wall fracture without substantial complications. The far posterior medial volume may not contribute significantly to the development of posttraumatic enophthalmos.