Transantral Orbital Floor Reconstruction in Children

Objectives: To determine the opportunities of orbital floor fractures reconstruction in children through the maxillary sinus using endoscopic assistance.

Methods: In a year about 91±16.3 children with fractures of the facial skeleton admit to our Institute. 67.9% have isolated craniomaxillofacial trauma. 71.4% were boys. Mean age was 12.4±3.7 years. Orbital trauma takes 64.3%. Fractures of the orbital floor dominate (63.6%). 42.9% of them are isolated.

Results: In children with fractures of the orbital walls surgeries were needed in 39.7±2.7%. 48.2% of operations were done in first 24 hours. In 46.2% we used intraoral approach and trepanation of the anterior wall of the maxillary sinus, in 30.8% -- subciliar incision, in 23% -- both approaches. An indication for transantral approach: isolated trapdoor fracture, paraorbital tissue entrapment that leads to pain syndrome or restriction of eye movements. We used endoscopic assistance in all children under 12 years. Perform a thorough sanitation of the sinus, remove the mucosa and assess the easiness of hernia reposition and the size of diastase between the bone fragments. Reconstruction was done in 57.1% of cases. Type of reconstruction depended on the age and size of the maxillary sinus. In children over 11 years we used titanium mesh. In children of younger age – non-resorbable porous implant. Postoperative complications were seen in 1.25%. Relative contraindication – age up to 5 years. Implants are not removed.

Conclusion: In proper patient selection transantral orbital floor reconstruction leads to good aesthetic and functional results. Allows to perform surgeries early regardless of edema of paraorbital tissues. This technique allows to assess the posterior edge of the fracture and the fullness of hernia reposition. Transantral approach should be used as often as possible in children who most frequently have fractures of the orbital floor and for whom the absence of scars on the face is important.