Clinical Analysis Of The Endoscopic Nasal Septum Cartilage Repair Of The Orbital Medial Wall Fracture

Objective:To explore the clinical efficacy and feasibility of endoscopic nasal septal cartilage repair of the unilateral orbital medial wall fracture,We performed a case control study between the nasal septum cartilage repair approach and the traditional medial canthus one.Method: Sixty cases of the unilateral orbital medial wall fracture were recruited in the fourth hospital of Zhangjiakou from June 2013 to March 2017,who were divided into two groups including the study group(Group A)and the control(Group B),and each group had 30 cases.Group A underwent transnasal endoscopic repair by the resected nasal septal cartilage,while Group B were conducted by the traditional inner canthus appoach.Several check indexes of the pre-operation and post-operation were compared,including visual acuity,eyeball invagination,eye movement disorder,diplopia and facial restoration.Result:1.Vision and the status of the anterior and posterior segment of the eyeThere was no decrease in the naked and corrected visual acuity of all cases postoperatively,and no significant changes were observed in the anterior and posterior segments of the eyes.2.Invagination of eyeballBy comparing the preoperative inter-group data of eyeball invagination,No significant difference was observed(P>0.05).The intra-group condition of preoperative and postoperative diplopia were compared respectively,The P value of Group A was less than 0.001,while Group B was less than 0.001.indicating that the two approaches were effective in the treatment of diplopia.The inter-group data of eyeball invagination recovery were compared at 6 months after the operation,and there was no statistical difference(P>0.05).3.DiplopiaBy comparing the preoperative inter-group data of diplopia,No significant difference was observed(P>0.05).The intra-group status of preoperative and postoperative diplopia were compared,The P value of Group A and B were either less than 0.001,manifesting that the two approaches were valid in the therapy of diplopia.The inter-group data of diplopia recovery were compared at 6 months after the operation,and there was no statistical difference(P>0.05).4.Eye movement disordersThe preoperative inter-group data of eyeball movement disorders were compared,and there was no significant difference(P>0.05).The intra-group status of preoperative and postoperative eyeball movement were compared,The P value of Group A and B were either less than 0.05,indicating that the two ways were effective in the treatment of eye movement disorders.The inter-group data of dyskinesia were compared at 6 months after the operation,and there was no statistical difference in P>0.05.5.Orbital volumeBy comparing the preoperative inter-group data of orbital volume,No significant difference was observed(P>0.05).The intra-group status of preoperative and one month postoperative orbital volume were compared,The P value of Group A and B were either less than 0.001,demonstrating that both the two approaches were impactful on the recovery of orbital volume.The inter-group data of orbital volume were compared at one month after the operation,and there was no statistical difference(P>0.05).6.Facial scarNo facial swelling and facial scar were found in Group A.There were facial scars in the control group,and some patients with hypertrophic scar.7.Complications of endoscopic sinus surgeryThere were 2 cases of nasal mucous adhesion and no other complications.Conclusion:The endoscopic surgery with nasal septum reconstruction of the orbital medial wall fracture is efficacious.No obvious differences in the improvement of invagination,diplopia,eye movement disorder,and the recovery of orbital volume.However,there is no incision on the surface of the nasal endoscopic,without scar,which does not affect the facial appearance and reduces the psychological burden of the patients.